Innovative Approaches to Redefining Care Delivery

Innovative Approaches to Redefining Care Delivery. A clinician stands with her hands open and in her hands is a red cross surrounded by icons of an ambulance, testing, a medical bag, blood, location, pharmacy, hospital, laboratory, and cybersecurity.

Senior health care executives and innovation leaders recently came together to discuss innovative approaches to achieving sustainability, delivering greater value and redefining delivery models. The virtual AHA Leadership Summit produced a wealth of insights about the path forward on transformation. Here are key lessons from two sessions.

The Next Frontier in Care Delivery: Hospital-at-Home (HaH)

A clinician takes a patient's pulse in a hospital-at-home setting.If there is a silver lining in the pandemic, it’s that it rapidly accelerated hospital-at-home programs. The Centers for Medicare & Medicaid Services (CMS) recognized the potential for these programs with a waiver last November. Today, roughly 130 early adopter hospitals have applied for and received the waiver to provide hospital-level care in the home.

Presenters from Mount Sinai Health System, the Johns Hopkins University School of Medicine and Brigham Health noted that results from ongoing domestic research in controlled, randomized trials largely mirrors impressive findings from decades of international studies on hospital-at-home programs. Namely, HaH programs can sharply reduce costs while maintaining quality and safety levels and lowering readmissions with improved patient experience.

And while questions remain about whether reimbursement for these services will continue once the public emergency abates, Bruce Leff, M.D., professor of medicine at the Johns Hopkins University School of Medicine, believes hospital-at-home programs are poised to expand.

4 Tips for Expanding or Launching an HaH Program

Explore Low-Hanging Fruit

Build on your foundations in home-based primary care and identify conditions you can readily treat in the home before branching out into more complex situations such as patients coming off complicated chemotherapy regimens, says Albert Siu, M.D., director, Mount Sinai at Home, Mount Sinai Health System.

Eschew Small Pilot Programs

It takes just as much work to build an HaH program as it does a pilot, Leff notes. Anticipate that it may take 100-200 meetings to coordinate and develop the logistics for a successful program.

Expand Your Focus

Mount Sinai initially focused on six conditions in its program, says Linda DeCherrie, M.D., clinical director, Mount Sinai at Home, Mount Sinai Health System. Today, leaders focus on the treatment plan, not conditions. “We know what we can and can’t operationalize in the home and it’s not necessarily based on the diagnosis,” she says.

Rally Support

Every department in the organization should know about this effort and should be brought in to help support the program, says David Levine, M.D., assistant professor of medicine, Brigham Health, Harvard Medical School.

Looking for resources to learn more about HaH programs or to support your efforts? The Hospital-at-Home Users Group offers tools and technical assistance, including help with filing for the CMS waiver. The AHA’s Hospital-at-Home webpage offers case studies and a webinar series on implementing an HaH program.

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