In this week's The Winning Edge webinar, executives from three leading health systems discussed how the platform improves clinical outcomes, reduces hospital overcrowding and costs, and boost patient satisfaction and engagement.

Despite challenges with reimbursement and complexity, the Hospital at Home strategy will be a key element of value-based care from here on.

That's the opinion of executives from three leading health systems who took part in this week's HealthLeaders The Winning Edge panel. They said the program, which enables patients to receive acute-level care in their homes rather than a hospital through a mix of virtual, digital and in-person services, has already proven its value.

Tuesday's panel featured Stephen Dorner, MD, MPH, MSc, chief of clinical operations and medical affairs for Mass General Brigham, which serves roughly 400 patients a month in a program launched in 2017; Daniel Davis, MD, senior medical director of primary care for the greater Charlotte market and senior medical director of continuing health for the Southeast region for Atrium Health, whose program includes one of the first pediatric Hospital at Home platforms in the country; and Logan Davies, MD, MBA, hospital medical director of access and throughput for Ochsner Health, which launched its first acute care at home program a little more than a year ago and is not following the Acute Hospital Care at Home (AHCaH) model favored by the Centers for Medicare & Medicaid Services (CMS).

The three programs follow a familiar pattern but have their own unique variations, which is a strength of the strategy. While roughly 400 health systems and hospitals are following the CMS model and receiving Medicare reimbursements through a pandemic-era waiver due to expire this fall, many others are developing their own programs, with the goal of taking patients out of crowded hospitals, reducing excessive hospital-based costs and enabling patients to recover at home.

Davis said the CMS model offers "an important sign of legitimacy," but it's not the be-all and end-all of the program. Healthcare organizations across the country are struggling to redesign care in a more efficient and effective format, and a model that takes care out of the hospital and puts it in the home fits that plan.

Here's the You Tube presentation of this week's webinar:

 

Nursing shortages, wellbeing, and workplace violence continue to be major areas of concern for CNOs, says this nurse leader.

As part of the role, CNOs and other nurse leaders constantly have to face evergreen challenges head on, and be ready to pivot to meet new ones.

Now that we are nearing the halfway point of 2025, it's time to check in on the issues facing CNOs today.

HealthLeaders spoke to Dr. Brad Goettl, chief nursing officer at the American Nurses Enterprise, about the three main areas of concern for nurse leaders: workforce shortages, workplace violence, and nurse wellbeing. Tune in to hear his insights.

The announcement speaks to a subtle shift in the Hospital at Home strategy, and an understanding that care needs to be more integrated and personal

Sometimes the retail experience just doesn't work out for healthcare.

Less than four years after acquiring digital home health company Current Health, Best Buy has sold the company back to its co-founder and former CEO, Christopher McGhee.

The move ends an interesting chapter in the Hospital at Home strategy that saw health systems like OSF HealthCare, Baptist Health, Geisinger, UMass Memorial Health, Atrium Health and Virtua Health use the ‘Geek Squad' to set up patients for home-based care and handle daily monitoring.

In a message on the company's website, McGhee pointed out that the Hospital at Home concept – as noted in a HealthLeaders The Winning Edge webinar this week – has been growing steadily.

"Compared to 2014, many more patients across the U.S. now have access to healthcare outside the hospital," he wrote. "But, ultimately we are still in the early innings of the shift from hospital-based care to home and community-based care."

The Hospital at Home concept focuses on delivering hospital-level care at home to certain patients who would otherwise be hospitalized, using a mixture of telehealth, remote patient monitoring and daily in-person care. The Centers for Medicare & Medicaid Services' (CMS) model, called Acute Hospital Care at Home (AHCaH), took off during the pandemic and now boasts close to 400 health system and hospital partners, with a pandemic-era waiver enabling participants to receive Medicare reimbursement.

While some healthcare organizations have developed their programs internally, using their own doctors, nurses and Mobile Integrated Health (MIH) programs to handle home visits, others rely on home health agencies or even vendors. Many outsource the technology part of the program, using companies like Current Health to evaluate patient homes, set them up with the right technology and handle daily monitoring.

Health systems who partnered with Current Health saw the relationship as a much-needed shot of retail strategy, and the idea of sending the Geek Squad to a patient's home to set them up for home-based care was a good one, enabling the hospital to handle oversight and escalations and leave the daily monitoring to someone else. But Best Buy's decision to get out of the home health business shows there is still work to be done.

Critics of the Hospital at Home strategy say the concept – particularly the CMS model - is too complicated, resulting in more costs and complexity than either the health system or the patient wants. They also question whether patients and their caregivers really want that much care in their homes, disrupting their daily lives and habits, and that those patients should be receiving care in a hospital.

Many of those invested in the Hospital at Home strategy say the program will go on with or without the Medicare waiver, which is set to expire at the end of September unless Congress takes action. But there's also a lot of discussion that the program needs to evolve to become more sustainable, and that a Hospital at Home program will look much different in a year or two than it does today.

The Best Buy decision may force health systems and hospitals to look more closely at how that care is delivered to the home, and to consider a more personal approach.

With that in mind, some providers are either rethinking their approach to the home or putting more effort into working with patients and their families to make the program less intrusive. That would mean replacing the Geek Squad with a hospital-based (or hospital-supported) team.

In his letter, McGhee said Current Health will be "recommitting to our mission" and working on a platform that integrates healthcare with the home setting. That might come as a relief to patients who'd rather see their healthcare delivered by a health system rather than a Big Box store.

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 program, which is called Acute Care at Home, 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.

Developing a virtual nursing program begins with incorporating cross-functional teams, says this CNE.

Virtual nursing is rapidly becoming a standard of care in the healthcare industry.

Right now, while many programs are still in their infancy, CNOs have a great opportunity to learn from each other's strategies and outcomes.

Here are three tips from Patty Donley, senior vice president and CNE at WellSpan Health, on how to build a virtual nursing program. 

Click here to read the accompanying article.

At HFMA, themes of payer collaboration, operational leadership, and smarter investments are dominating the conversation.

HFMA attendees are settling in on day two of the annual conference, discussing key issues that are focused on the deep-rooted finance issues in healthcare.

Three of the most pressing topics for finance leaders in the sessions so far are:

• Working better with payers (and what that really means);
• Stepping into the role of operational transformation leaders, and
• Making the most of health system investments in today’s heated economical and regulatory climate.

Pacing Payers

Payers and prior authorization are on everyone’s agenda, with sessions focusing on denial prevention, simplifying claims creation and prior authorizations, and strategies for taking the friction out of payer-provider relationships.

Providers are rapidly embracing AI and automation in claims processing, but they’re also aware that payers are using the same technology, and more often than not, they’re faster and more efficient. So instead of sinking into a battle of the bots, both parties should be working together to create a claims/prior authorization process that revolves around the patient.

From aligning managed care and revenue cycle, to uncovering better claims processes, to digging into more comprehensive (but more efficient) coding practices, providers are searching for new ways and new perspectives to approach their relationships with payers.

The first step is defining performance improvement and what it means to a particular health system. CFOs need a proactive approach to tying financial outcomes with performance, one that involves strategic alignment, especially for the long-term.

To set their health systems up for clearing the (seemingly never-ending) industry hurdles, finance executives are taking a close look at, and in some cases overhauling, their investment portfolios. But finding liquidity is easier said than done.

To help, CFOs are turning to private market investments for returns, and leveraging peer comparisons to reassess risk exposure. Looking at the organization through an enterprise lens is vital; one session advised CFOs to ask their finance team: "Are we taking the right risk through an enterprise perspective?"

There are a few different use cases for virtual nursing in the emergency department, says this CNE.

On this episode of HL Shorts, we hear from Patty Donley, senior vice president and CNE at WellSpan Health, about how to implement virtual nursing in the emergency department. Tune in to hear her insights.

Executives from three health systems leading the way in developing Hospital at Home programs will discuss the benefits, drawbacks and future of the concept in this week’s Winning Edge webinar.

Hundreds of health systems and hospitals across the country are using Hospital at Home programs to treat acute care patients at home instead of in the hospital, yet the future of the program is still uncertain.

Advocates swear by the program, saying it reduces wasteful costs and improves clinical outcomes, while critics say the program is complex, leads to extra costs and isn’t best for patients or their families. And the Centers for Medicare & Medicaid Services (CMS), which crafted waivers for its Acute Hospital Care at Home (AHCaH) program during the pandemic to help providers collect Medicare reimbursement, is currently planning to end that waiver in September.

Against this backdrop, HealthLeaders will convene executives from three health systems to discuss the benefits, drawbacks and future of the Hospital at Home program in its latest Winning Edge webinar on Tuesday. The Winning Edge for Moving Forward With the Hospital at Home Strategy will take place at 1 p.m.

The panel promises to be informative. It features Stephen Dormer, MD, MPH, MSc, chief of clinical operations and medical affairs for the Healthcare at Home program at Mass General Brigham, which developed one of the earliest and most successful Hospital at Home programs in the country; Daniel Davis, MD, senior medical director of primary care and senior medical director of continuing health (Southeast Region) for Atrium Health, another front-runner in the Hospital at Home movement; and Logan Davies, MD, MBA, hospital medical director of access and throughout for Ochsner Health, which has developed one the country’s most extensive telehealth and remote patient monitoring platforms.

The panel will discuss how healthcare leaders are defining and developing ROI for these programs, which combine telehealth, remote patient monitoring and in-person care to treat selected patients in their won homes instead of hospitalizing them. We’ll also talk about how technology is integrated into the home setting, how in-person visits by care teams are scheduled, and how patients and their families are included in the planning process.

Close to 400 hospitals and health systems are following the CMS ACHaH program, which features a rigid structure but offers Medicare reimbursement. Many others are trying out different versions of the acute care at home strategy, which eliminates reimbursement but gives them the freedom to develop their own structure.

Advocates say the model could be a key strategy in reducing crowded inpatient units and improving outcomes for rural patients, as well as populations like children, veterans and those with chronic care needs.

Tune in on Tuesday to learn more.

Addressing the nursing shortage requires a careful, multipronged strategy and a mindful approach.

The national nursing shortage is an ongoing pain point for CNOs and for healthcare organizations across the country.

It's critical for CNOs to understand why the nursing shortage is happening and the full extent of its impact, so they can develop robust strategies for combatting it.

According to Dr. Brad Goettl, chief nursing officer at the American Nurses Enterprise, the nursing shortage impacts a health system's financial situation and care delivery for patients. 

Economic impact

CNOs need to know that the nursing shortage has more of an impact on some areas than others, and there are still many people who are interested in becoming nurses, Goettl explained. However, there is a shortage in faculty and training capacity in educational settings.

"I like to point that out because it really is part of the solution to the workforce, making sure that we have enough training capacity at our universities to be able to get people that are interested and qualified through training programs so they can get out there and take care of our patients," Goettl said.

From an economic perspective, it's expensive to operate under workforce shortages. Labor costs are higher across the country in every aspect of healthcare, Goettl explained, but having to fill the gaps with agency nurses and overtime pay is also costly. Average turnover can cost a typical hospital anywhere between $4 million to $6 million a year.

"That can turn into this cyclical process where people are working too much, they get burnt out, and then they call out and then we're short," Goettl said. "We know that the average cost of turnover of a nurse can be upwards of $40,000 to $60,000, and it's only going up as labor costs are going up."

According to Goettl, there are significant financial returns from investing in turnover.

"Hospitals that invest in this, for each percent change that they decrease their turnover, they can save almost $300,000 a year," Goettl said, "so that investment in retaining your staff and keeping your staff and investing in your staff really comes full circle."

Patient care delivery

The impact on care delivery is largely straightforward: If there are not enough nurses to take care of patients, or if nurses are spread too thin, patient outcomes suffer.

"We have a healthcare capacity issue," Goettl said. "It's not just happening in the acute care hospital environment, but really all clinical environments, and patients are often being held all over the hospital while they're waiting for rooms, or there are delays in getting outpatient treatment [and] elective or semi-urgent procedures."

This causes barriers to healthcare access, and in turn that negatively impacts public health, Goettl explained.

"We know that there are poor outcomes to patients that are being treated at facilities that have nursing shortages or are understaffed," Goettl said. "That can translate to increases in pressure ulcers or outcomes, falls, increased mortality rates, and even nurse injury because you're not able to have your nurse colleagues help you with lifting, boosting, or needle safety."

Filling coverage gaps

For CNOs who are working towards addressing these shortages, Goettl recommends caution when developing staffing strategies.

"Don't spread your staff so thin and then make that the new normal," Goettl said. "[You] still have to invest in appropriate and safe nurse staffing, but the big investment is in professional development, providing opportunities for other healthcare professionals like techs and LPNs to go back to school so they can stay in the health system."

Goettl emphasized the role of virtual nursing as well, as an opportunity to augment staffing. Virtual nursing can help with teaching, peer-to-peer mentorship, and retaining seasoned nurses who can work as preceptors or as clinical mentors.

"It doesn't replace a nurse, but it can definitely help in scenarios where you need to spend more time with patients," Goettl said.

Work-life balance is critical for nurse retention, Goettl said. Solutions such as self-scheduling and flexible scheduling can give some autonomy back to the nurse and simultaneously help fill up the schedule while empowering nurses to do what's best for them. Investment in transition to practice programs is also key.

“Investing in your nursing staff so that they have the tools [that prepare them] to do their job will help with retention all the way around," Goettl said.

A robust virtual nursing program should be created with long-term goals in mind, says this CNE.

HealthLeaders spoke to Patty Donley, SVP and CNE at WellSpan Health, about the health system's virtual nursing program and how to develop a virtual nursing strategy. Tune in to hear her insights.