Providers Betting Big on Future of Hospital at Home

Mass General Brigham wants to move 10% of its medical patients to home care. “That’s just our starting point,” said Heather O’Sullivan, R.N. and president of the system’s Healthcare at Home, in March at HIMSS. “There’s actually research out there showing that 30% to 40% of all care provided in the U.S. today can be moved to the home.”

Mass General Brigham has one of the largest acute care-at-home programs in the country. It expanded to 50 beds in March and plans to have 70 beds by the end of 2024. The health system’s move to home care has been fueled by the Centers for Medicare & Medicaid Services' (CMS) Acute Hospital Care at Home (AHCAH) initiative, which is set to expire at the end of the year. Hospitals approved for the AHCAH waiver can provide inpatient-level care in the home for Medicare fee-for-service and non-managed care Medicaid beneficiaries.

The hospital at home (H@H) model has grown significantly since CMS launched its waiver program in 2020 to help mitigate capacity issues during COVID-19. A growing body of research shows that the model is an effective strategy that can shorten length of stay, reduce readmission rates, prevent health care-acquired infections and lower health care costs.

However, many health systems depend on the CMS waiver to sustain their programs and are struggling to expand or develop long-term plans with the threat of losing that reimbursement at year’s end.

The University of Chicago Medicine received a CMS waiver to launch a hospital at home program. This AHA Market Scan video case study explores how UChicago Medicine developed its program, successes and challenges, and strategy for future expansion. WATCH NOW.

The Rise of Hospital at Home

The hospital at home model was developed in 1995 by Johns Hopkins University School of Medicine. Researchers tested the concept at several Medicare managed care sites and reported a cost savings of about 30% compared with traditional inpatient care; better clinical outcomes; lower average length of stay; and fewer lab and diagnostic tests.

Other hospitals used the John Hopkins model to launch pilot programs but struggled to secure reimbursement or regulatory flexibility from CMS or private payers to sustain the programs.

After CMS launched its waiver-based program in 2020, hospital at home programs quickly moved from an experimental to a strategic priority for many health systems. By April 2024, CMS had authorized more than 320 hospitals across 133 health systems in 37 states to offer acute hospital care at home, and those numbers are climbing. A Chilmark Research report from May 2023 projects the program will double by 2026 — if Congress extends the CMS waiver initiative.

Positive Outcomes, Cost Savings Fuel Growth

Advocates are citing studies that demonstrate the program’s value — both in patient outcomes and savings — to convince lawmakers to make CMS reimbursements permanent. More than 60 different conditions, including congestive heart failure, pneumonia and chronic obstructive pulmonary disease, can be treated at home with proper monitoring and treatment protocols with a CMS waiver.

CMS released data in November 2023, based on 11,000 patients admitted into AHCAH programs between November 2021 and March 2023. According to that research, patients who received hospital-level care at home had lower mortality rates and fewer complications compared with patients treated for similar acute conditions in hospitals. The overall proportion of patients transferred from home back to the hospital was 7.2%.

A study published in January by researchers at Mass General Brigham analyzed clinical outcomes for almost 5,900 patients across the country. It found that patients who were treated in the program saw lower mortality rates, fewer returns to the hospital and less time spent in skilled nursing facilities.

Research also supports the cost value of hospital at home programs. Johns Hopkins reports a savings of 19%-30% when compared with in-hospital care. Atrium Health, which plans to treat 100 patients at home daily by year-end, projects the program will free up 10% of its inpatient hospital beds by 2025.

What’s Next?

McKinsey & Company estimates that as much as $265 billion worth of care services, representing up to 25% of the total cost of care for Medicare fee-for-service and Medicare Advantage beneficiaries, could shift from traditional facilities to the home by 2025 without a reduction in quality or access. However, reimbursement and infrastructure challenges could impact adoption of H@H programs.

H@H programs save money in the long term by reducing overhead, readmission rates and other significant cost drivers. However, program implementation is a complex and costly process. Organizations must invest heavily in new information technology, staffing and workflow systems to provide and scale care for a sizable patient population.

Provider organizations are offloading some complexities associated with hospital-level home care by partnering with outside technology and services vendors. In November 2023, Mass General Brigham partnered with Best Buy Health to support and expand its program.

Some hospitals have been reluctant to invest resources in the program and many commercial payers are waiting to sign on while the CMS waiver extension remains uncertain. CMS is gathering comments about H@H and will make recommendations to Congress this fall.

Extending the H@H program is a major AHA priority this year. In March, the AHA said in a statement to the House Ways and Means Committee: “We look forward to working with Congress to extend the H@H program and permanently adopt telehealth waivers, which will provide additional opportunities to collect important quality, patient experience and reimbursement data that can help shape a permanent version of these programs.”