3 Strategies for Scaling Hospital at Home — from Leaders Who've Done It

Most health system executives recognize the value of hospital at home programs. What they want to know is how to build it and scale it. A growing body of evidence — and a cohort of leaders who’ve done it — is making that roadmap clearer.

A major study published this spring in JAMA Network Open analyzed outcomes for nearly 16,000 Medicare beneficiaries and found that hospital-at-home patients had dramatically lower in-hospital mortality — 0.4% compared to 3.6% for traditional inpatients — along with fewer ED visits within 30 days, lower rates of ICU escalation and hospital-associated complications, and lower post-discharge costs. At the AHA Leadership Summit last month in Denver, three executives shared what the data alone can’t tell you: what it actually takes to build, scale and sustain hospital at home in the real world.

1 | The outcomes support change management.

Building a hospital-at-home program is requires both technology and care teams, and leaders have used change management strategies to help get their entire organization fully engaged.

John Couris, president and CEO of Florida Health Sciences Center, a large academic health system with eight hospitals across Florida, oversees an expansive hospital at home program, extending the platform to other health systems including NewYork-Presbyterian.

“It’s not about whether it works,” he said. “We know hospital at home works.”

His system’s readmission rates for hospital-at-home patients are half those of similar patients treated in a traditional setting. Patient and team member satisfaction are both in the 99th percentile.

But none of that came without friction. “This is a big change management activity,” Couris said. His prescription: Build multidisciplinary teams around the problem, not the program.

“You have to fall in love with the problem, not the program,” he explained. “You’ve really got to build something that’s going to drive better outcomes and lower cost for the communities you serve.”

Avera McKennan Hospital and University Health operates nearly 40 hospitals across eastern South Dakota, northwest Iowa and southwest Minnesota, most in communities with fewer than 5,000 residents. Its regional president and CEO, Ron Place, M.D., a retired Army Lieutenant General, views the shift toward home-based care as an augmented form of earlier models.

“A hundred years ago, being treated at home was usual — that’s how we actually did things,” Place said. Technology is enabling patients access to acute services back in the home setting.

“So many things are better at home,” Jacqueline Keene, DNP, nursing leader for hospital at home at The Ohio State University Wexner Medical Center, learned that lesson firsthand. Ohio State’s first program achieved a 50% reduction in readmissions and is relaunching with an insourced model of Ohio State nurses and physicians rotating between inpatient and home settings, with a long-term vision that includes offering a wider range of services at home.

Key Takeaway

The outcomes data are compelling. The real work is organizational: getting clinical teams to engage with the model, building referral pathways and designing a program that fits your community. Find your early adopters and let the results do the persuading.

2 | Technology enables the program. Your clinical team sets the boundaries.

Florida Health Sciences Center partnered with Palantir to build a predictive analytics backbone across the entire system. In its Level 1 trauma center ED — running at 97% occupancy — the platform identifies admitted patients waiting for beds who are appropriate for hospital at home, freeing capacity for patients who need emergency care. The system now maintains an average daily census of 26 hospital-at-home patients, with a long-term goal of 125 to 150, roughly the size of a community hospital.

Place takes a proactive approach, integrating sensors on hospital-at-home patients to detect clinical deterioration before it becomes a crisis.

“We’re finding things before the nursing staff would find them on a home visit,” he said.

The philosophy comes directly from his military background managing care across dispersed combat environments.

“In South Dakota, people live on farms and ranches,” Place said. “How do you serve them? You use technology to bring care to where they are.”

Key Takeaway

Technology is infrastructure, not strategy. Work with clinical teams to prioritize patient populations best suited for hospital at home and expand as confidence grows. Remote monitoring of patients at home enables rapid detection of clinical changes and action from the care team.

3 | Innovation helps build capacity in new ways.

Perhaps the biggest change stemming from hospital at home is how it builds hospital capacity. Rather than building traditional inpatient beds, it can be built in homes enabled by technology and virtual presence. Couris notes that at his academic medical center, moving a transplant patient to hospital at home when they’re clinically ready helps opens a bed for the next transplant patient.

“We’re using hospital at home to strategically grow volume,” he said concerning capacity for transplant patients. “And when the naysayers see that, they become the believers.”

The federal policy environment is also moving in the right direction. The hospital-at-home waiver has been extended through 2030, and Place is optimistic about the case for permanent authorization.

“The results are undeniable,” he said. “There is a real hunger for practical innovation and legislators are very open to it.”

At Ohio State, Keene built buy-in one conversation at a time — walking inpatient units to answer questions from bedside nurses. Can we wean a patient off oxygen at home? Yes. IV Lasix? Yes. Continuous infusions? Yes. The turning point came when nurses started sending her unsolicited referrals.

“I took that as the win,” she said. “That’s when I knew the culture had shifted.”

Key Takeaway

Make the capacity argument explicit: Hospital at home augments capacity and access for more patients and communities

The Bottom Line

Building a hospital-at-home program requires more than good technology and compelling data. It takes a willingness to rethink deeply ingrained assumptions about what a hospital is, where care happens and who decides. As Couris put it: “We have to change the paradigm. We have to do something — or something is going to be done to us.”