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.

[Also read: New Study Questions Lack of Rural Hospital at Home Programs.]

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.

Goldblatt said the effort, alongside the U.S. Food and Drug Administration’s Home as a Health Care Hub, aims to better understand the ROI Hospital at Home and other programs that bring care into the home.

“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.”

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.

Allina Health is using technology and new ideas to reduce the time a patient spends in the hospital. They're seeing improved outcomes, reduced costs and more capacity to treat patients who need to be hospitalized.

One of the key metrics in clinical care is patient length of stay (LOS), traditionally defined as the time between a patient's admittance and discharge from a hospital. LOS is a critical factor in everything from reimbursement and accreditation to patient satisfaction and clinical outcomes.

New technologies like AI and concepts like remote patient monitoring (RPM) and Hospital at Home are helping healthcare executives gain a better understanding of LOS, and in turn they're reducing costs and improving care management.

"We usually think about length of stay as an inpatient issue, but it really isn't," says Hsieng Su, SVP and Chief Medical Executive at Allina Health. The Minnesota-based health system has seen double-digit reductions in average LOS by improving care coordination between its 12 hospitals and various care sites, improving outcomes and opening up beds for new patients.

The key, Su says, is to understand the relationship between hospitals and other care sites, like skilled nursing facilities (SNFs), rehab centers and even the home, and developing a care management plan for the patient that makes the best use of those sites, rather than adhering to old protocols or patterns. That means collecting and analyzing data on the patient and various sites of care outside the hospital and finding the best care pathway.

"This needs to be a very deliberate and focused strategy," she says.

While the LOS issue reached its peak with the pandemic, when hospitals were swamped with patients and struggling to find places to care for them, its roots go much farther back, to when healthcare organizations began setting expectations on how long a patient would have to be in a hospital to receive treatment for certain health concerns. Arrayed against those expectations were the costs of keeping a patient in the hospital and the amount that a health plan or payer would pay for that care.

Nowadays, those assumptions are being upended. Patients can be admitted to a hospital for surgery and discharged within a day to another care site. Healthcare organizations are using RPM and telehealth to monitor patients at home (or another facility) who might otherwise spend an extra day or two in the hospital.

That's why it's critical for healthcare executives to have a clear understanding of their options to the inpatient stay.

Su says the push to develop a better LOS strategy came out of the COVID-19 pandemic, when inpatient beds were at a premium and more than 100 patients each day were ready to be discharged, but hospital staff couldn't find the right facility to take them.

"They couldn't deliver care, so we were just hosting them while they were waiting," she says. "And that is not satisfactory for our patients or our community."

Allina launched a partnership with Navvis to reduce those bottlenecks and backlogs through improvements in "patient throughput". In the first 12 months of that partnership, the health system was able to reduce average LOS for discharge to an SNF by 1.61 days and by .89 days for discharge to a home health program. The health system also saw reductions in ALOS to hospice care and LTACH facilities.

This, in turn, enabled the health system to free up 25,000 days of capacity, or room for an additional 5,000 patients.

"Nobody really wants to be in a hospital unnecessarily," Su points out. So it's in the best interests of both the patient and the health system to find the right resources to reduce that LOS.

She says traditional care huddles have focused on clinical care, but now the conversations are more holistic, centered on what the patient wants as well as needs. Care managers and social workers are incorporated into the conversations, and plans are to add caregivers and even family members.

"This is a very clear conversation," she says, about the patient's care journey, with data to back up the various care pathways. For example, she says, a patient admitted with pneumonia should be hospitalized for three to five days depending on current protocols, but that LOS can change depending on factors like the patient's response to treatment, availability of rehab beds or even the hospital's ability to use RPM or telehealth to care for that patient at home.

That includes asking hard questions about the alternatives.

"I'm seeing in so many programs now that in many cases, these clinical programs don't really think about what happens in the home when these things move to the homes," Su says. "They have to be thought out."

"We want to make sure they don't end up coming back to the hospital," she adds.

At the end of the day, Su says, Allina is reducing the time that patients spend in a hospital by giving them better options, and the health system is using technology to make sure those options are safe and effective. This reduces the cost of care, improves the patient's outcomes and outlook, and enables the hospital to care for more patients who need to occupy those inpatient beds.

The Memorial Hermann Health System is partnering with a digital health company to make sure patients undergoing cancer treatment have a care team around them at all times—especially at home.

Health systems looking to maximize care for patients undergoing cancer treatment are finding value in innovative partnerships that focus on care management and monitoring at home.

"At 3:00 in the morning when a patient is awake and afraid and has pain that they've never felt before, or a nausea that is unceasing, and they've maybe forgotten [to] take that medication, they can pick up the phone," says Sandra Miller, MHSM, RN, NE-BC, VP of the oncology service line at Houston's Memorial Hermann Health System. "They can call, they can talk to someone right away, who can then help them to deescalate and think clearly about what next steps would be."

Those patients aren't necessarily calling the hospital. They're calling a care team employed by Reimagine Care, a Nashville-based company that focuses on cancer care services in the home. That team, which includes oncology nurses and advanced practitioners, enables patients to access care on-demand, while giving Memorial Hermann a platform on which to integrate its clinical team.

"It's a good model for this type of program because we know that cancer patients are terrified," Miller says. "Their levels of anxiety and depression are very high. They need a very strong support team … as an additional component to their family members and their clinical teams that see them regularly."

Partnerships like this are a crucial factor to improving care management and coordination at a time when health systems and hospitals are dealing with workforce shortages and inpatient care stresses and embracing concepts like remote patient monitoring (RPM) and home-based care. Through programs like collaborative or connected care, they can create programs around patients with complex care needs.

And they'll become more important as healthcare innovation leaders develop the Hospital at Home concept and look at improving care coordination for patient groups, such as those with chronic conditions.

Miller points out the partnership enables Memorial Hermann to focus on inpatient and acute care—care for which patients either need to be in a hospital or need to be seen by a clinician—while separating the tasks and services that fill up their workflows but could be handled by other members of the care team.

"It relieves the burden of late nights and overtime and late hours for providers and for nurses," she says.

Reimagine Care is one of dozens (if not more) of companies that have sprung up over the past two decades to tackle care management outside the hospital, offering 24/7 services and the ability to hand off to the hospital when the need is escalated.

The company's CEO, Dan Nardi, says Reimagine Care focuses on cancer care and targets a pervasive pain point for hospitals: Managing care outside the hospital or doctor's office and in between the visits. He cites research conducted in 2023 that found that 82% of patients want to be treated as much as possible at home, and more than 90% want to be able to connect with a member of their care team on demand, whenever they need to make that connection.

Without this type of partnership, a patient might call a doctor's office or hospital and find there's no one to talk to at that moment, and then they might decide to go to the Emergency Department.

The ER "is the last place they want to be," says Miller. She notes that in the year and a half that Memorial Hermann has worked with Reimagine Care, unplanned ER visits have dropped below the national average, while patient satisfaction has improved.

Miller says the platform is proving especially valuable to younger patients and those with families and jobs—patients who are balancing the demands of everyday life with their care routines and having little time to spend on trips to the doctor's office or ED beyond their scheduled visits.

And by creating a care team bolstered by Reimagine Care, Memorial Hermann is able to create room for more patients, especially those facing barriers to accessing care.

"This creates capacity for new patients," Miller says. "There are always patients waiting. There's always a wait time to see a new provider and we don't want patients to wait who have cancer. By being able to triage patients to home care or home support, we're able to see new patients who are waiting, who are sick, who need the attention and time of a medical oncologist. So creating capacity for new patients is paramount in this relationship."