The hospital-at-home model is expanding concepts of where and how acute medical care can be delivered. Hospitals can “admit” qualified patients into their homes, where they receive acute, hospital-level care through a combination of telemedicine, remote patient monitoring and in-person visits.
In November 2020, the Centers for Medicare & Medicaid Services recognized hospital-at-home care by launching the Acute Hospital Care at Home Program. The waiver program allows approved providers the flexibility to provide acute medical services in patients’ homes. More than 90 hospitals have joined the waiver program.
A recent issue brief from the AHA’s The Value Initiative explains how to set up hospital-at-home programs and shares success stories from leaders in the hospital-at-home field.
Pioneering Efforts to Improve Value
Hospital-at-home care improves outcomes and the patient experience while reducing the cost. Brigham Health in Boston has been a pioneer in this area, tailoring its home hospital program to patients who live within five miles of its two hospitals and who have acute conditions like pneumonia, congestive heart failure, asthma or complicated urinary tract infections.
In a randomized, controlled trial released in 2020, data from Brigham Health showed that the adjusted mean cost for acute care episodes was 38% lower for home hospital patients than control group patients without appreciably changing quality or safety. Home hospital patients were also more physically active and reported less anxiety. Investigators also found that the home hospital model decreased emergency department (ED) visits and readmissions after discharge.
Other providers that are having success in this area include Mount Sinai Health System in New York City, Presbyterian Healthcare Services in Albuquerque, N.M., Massachusetts General Hospital in Boston, the University of Utah Huntsman Cancer Center in Salt Lake City and UnityPoint Health in Iowa.
David Levine, M.D., lead author of the study and a physician and researcher at Brigham Health, also leads the Hospital at Home Users’ Group, a collaborative of hospital-at-home programs from across the country. AHA is partnering with the users’ group on an ongoing webinar series that provides practical information for hospitals looking to launch a hospital-at-home program.
New Entrants to the Hospital-at-Home Space
It did not take long for this innovative care model to expand. As many hospitals and health systems are still planning their strategy, Humana recently became the first national payer to stake its place in the market.
Humana is teaming up with in-home service provider DispatchHealth to deliver in-home emergency and acute care to Humana’s 8.4 million Medicare patients. Humana initially will provide DispatchHealth’s services to enrollees in Denver and Tacoma, Wash., before expanding into cities in Texas, Arizona and Nevada by year-end. The home health care provider will offer patients 24/7 remote monitoring by an internal medicine physician specialized in ED training, a physician’s assistant and a nurse’s assistant, along with daily visits from providers, including bedside nursing. Dispatch’s team will go beyond meeting members’ medical needs by addressing social needs, coordinating pharmacy deliveries, offering physical and respiratory therapy, imaging services and more.
Through its partnership with Dispatch, Humana is looking to expand significantly beyond the 550,000 home health visits it conducts each year. Humana eventually plans to offer the service to its 16.8 million enrollees, including Medicaid and commercial members.
For more resources on hospital-at-home, visit the AHA website.