All signs point to a bright and expansive future for hospital home programs, which have grown steadily since the Centers for Medicare and Medicaid (CMS) established the Acute Hospital Home Waiver Program in November 2020. As of March, nearly 100 health systems and more than 200 hospitals in 34 states have been approved for the program. Meanwhile, Forrester predicts that the number of hospitals providing acute care at home will triple by 2022. The reasons are compelling: study conducted at an academic medical center and a community hospital found that non-medical costs for care provided at home were 38% lower than for similar care provided in a traditional hospital setting. Patients are also less likely to be readmitted to hospital. Other studies tell a similar story, adding that patients are more satisfied and hospitals save on associated meal and housekeeping costs.
And yet, the pace of growth could be threatened if CMS ends the waiver program, which is due to expire when the current public health emergency (PHE) expires. On April 13, President Biden extended the PHE until at least July 2022. A bipartisan bill, the Inpatient Services Modernization Act, would further extend the waivers for another two years. Advocacy groups including Advanced Care at Home Coalition and Moving Health Home, as well as organizations such as the American Hospital Association, are pushing for a more permanent solution.
History and drivers
The idea of providing hospital care at home was first conceived by Dr. John Burton of the Johns Hopkins School of Medicine and Dr. Donna Regenstreif of the John A. Hartford Foundation in 1995, with the first pilot projects being launched the next year. Since then, several programs have studied and supported the development of additional programs, although the real growth has come in recent years, propelled by the pandemic.
Beyond reimbursement, demand for home care is expected to increase due to an older patient population with multiple chronic conditions. However, advances in remote patient monitoring (RPM) technology are helping to support the increased demand for virtual care. In fact, remote patient monitoring services and tools should reach 30 million patients in the United States by 2024. Cloud-based communication and collaboration technology is also supporting the transition.
Medically Home, founded in 2016, provides a technology platform that enables remote clinicians to communicate, share data and support care teams treating high acuity patients at home. Kaiser Permanente and Mayo Clinic were early investors in Medically Home, working in partnership with local organizations and suppliers to meet not only staffing needs, but also supply chain and IT. Trained a year earlier, Contessa identifies diagnoses that can be treated at home and manages reimbursement. In 2021, Contessa was acquired by Amedisys, a home care, hospice and personal care company.
Commercial payers and providers are gearing up for greater adoption. Humana acquired Kindred at Home and One Homecare Solutions, both of which provide home care. One Homecare also has experience with risk-based reimbursement models. Meanwhile, Baxter and Cardinal Health invested in Medically Home, while Owens & Minor acquired Apria, which makes integrated home health equipment. Home health agencies are also following suit, citing the home hospital as a primary target for greater involvement.
Critical questions
– Despite the enthusiasm and general interest, a number of key questions remain:
– Can more complex supply chains be designed to support the provision of human and material resources to significantly more sites?
– Can data be collected in a way that supports secure and consistent communication between the different parties involved in patient care?
– How can patients be assured that the caregivers who come to them are properly accredited and checked?
– Can the parties collaborate successfully to improve the patient experience, while minimizing duplication of effort?
– Will doctors adopt the models and will hospitals invest in the necessary technology and training?
– Will moving to patients’ homes increase health disparities given the difficulty low-income people have in finding affordable and adequate housing?
Critical success factors
Considering the opportunity and the obstacles, here are some factors to contribute to success:
– Know your patient population: The provision of home care increases the variables that need to be taken into account. Beyond the diagnosis, consider what else you need to know about the patient. For example, cultural issues, living environment and personal preferences.
– Engage supply chain professionals. Hospital at home requires expertise to match resources to needs, when and where they are needed. Supply chain professionals routinely work with multiple parties to coordinate the procurement, procurement, payment, and delivery of products and services, providing clinicians with the supplies and data they need to do their jobs.
– Interoperability: To allow interoperability between the different technological systems used by the different parties involved, which can be numerous for patients with several chronic diseases.
– Communicate clearly: Normalize data captured and shared to ensure consistency, accuracy, and clarity. Coordinate with other participants to avoid duplication in data entry to minimize duplication of effort and time spent by clinicians and patients in the process.
– Protect your data: Monitor and address cybersecurity threats and invest in safe data sharing with adequate privacy protections.
– Move smartly: Use technology that helps design the most efficient transportation routes and work to coordinate – not duplicate – the movement of people and goods.
– Accreditation: Put systems in place to equip clinicians with the licenses and training they need and ensure that anyone entering a patient’s home is properly accredited and vetted.
The home hospital is an idea whose time has come, and it is no longer a question of if but how quickly. The clinical and financial drivers are there, and at least for now, as are the reimbursement and flexibility that hospitals need. But perhaps the biggest driver of all will be patients and their families. Health systems that accelerated hospital-at-home programs during the pandemic have collectively recruited tens of thousands of patients. For many of these patients, value is defined not only by the quality of care, but also by the cost and convenience the home hospital provides.
About Karen Conway
Karen Conway serves as Vice President, Healthcare Value, for Global Healthcare Exchange (GHX), where she works to advance the role of the supply chain as a critical enabler of a value-based healthcare system. At GHX, she applies her deep knowledge of supply chain operations and systems thinking to align processes, data, and incentives across the entire healthcare ecosystem. She is also passionate about generating evidence on what improves the health of individuals and populations and the performance of the organizations on which an effective health system depends.