Hospital-at-Home Innovation During COVID-19 and Beyond

For many years, we have not questioned the traditional wisdom of hospitalizing acutely ill people for medical care. But what if some acutely ill people could receive high-quality medical care in the comfort of their own homes? And what if that care actually led to better outcomes, reduced costs and enhanced patient experience?

What was once a small but mighty contingent of health care systems providing “hospital-at-home” care before the pandemic has grown into a larger movement. With this model, hospitals across the country are “admitting” patients to their own homes for acute care with excellent results. As highlighted in AHA’s recent issue brief on hospital-at-home, patients receiving this care have a 20% reduction in mortality, were three times less likely to be admitted to an emergency department than usual care patients and have higher satisfaction with their care. And these results are achieved at a 25% lower cost of care.

The COVID-19 pandemic has spurred a number of innovations in health care delivery that have the potential to positively alter how care is provided in the years ahead. Hospital-at-home is one of those promising models.

As we move into a new era of health care delivery, hospital-at-home is an innovative model for providing quality, person-centered care. It gives hospitals an opportunity to be leaders in this space and shape what health care can look like for years to come.

Value and the Patient Experience

Hospital-at-home programs make acute, hospital-level care available to patients in their homes. This model of care is well suited for patients in need of hospital-level care that have conditions with well-defined treatment protocols, such as pneumonia, congestive heart failure, chronic obstructive pulmonary disease (COPD), diabetes or cellulitis.

Patients are consistently connected to their care team through a combination of in-person visits, video visits and continuous biometric monitoring via telehealth technologies. When health professionals visit the patient, they can provide a wide array of services including diagnostic studies, treatments and therapies that normally could only be delivered at a hospital.

Over the past few months, I have connected with leading hospital-at-home programs from across the country about their experiences. While I encourage you to listen to the podcasts to learn more about how these hospitals have implemented innovative care models that have demonstrated improved value — and to catch these leaders’ enthusiasm and passion for their work — here’s a glimpse into these programs.

• University of Utah Health’s Huntsman Cancer Institute offers the Huntsman at Home service to oncology patients, enabling them to leave the hospital sooner or avoid being admitted to a hospital altogether. Huntsman at Home patients had 48% fewer ED visits and 48% lower cumulative charges for clinical services. The health system is breaking new ground with an innovative rural pilot in eastern Utah: A local paramedic travels to the patient’s home while a hospital-based physician joins the visit by video conference to help guide the paramedic’s care services.
• Presbyterian Healthcare Services has been providing hospital-at-home care across New Mexico since 2008. Patient satisfaction scores are at 99%, and infections, falls and medication errors have been close to zero. The cost of care is 42% less than a hospital admission.
• Brigham Health admits eligible patients from the ED into their homes in the Boston area. Home hospital patients have 38% lower direct costs and also reported less anxiety, more control and more physical activity. Moreover, the 30-day readmission rate for home hospital patients is 7%, versus 23% for those receiving inpatient care.

As hospital-at-home programs continue to grow, I anticipate that we’ll hear more stories about how this model provides value for hospitals and the patients they serve. For a deeper dive into the nuts and bolts of adopting a program, explore the recent webinar series from our partners at the Hospital at Home Users Group.

Paying for Hospital-at-Home

Despite the promise of hospital-at-home for high-value care delivery, most payers do not yet cover the service. The Centers for Medicare & Medicaid Services signaled its support for this model in November 2020 with a new waiver for an Acute Hospital Care at Home program, but it is designed to last only through the COVID-19 public health emergency. Hospitals that have successfully navigated the payment challenge include the Veterans Health Administration network as well as health systems that have their own insurance plans.

There is reason to hope that there may be changes to how hospital-at-home is paid for. Recently, Intermountain Healthcare, Ascension, Amazon Care and several home-based health companies formed Moving Health Home. This coalition is working to change state and federal policies to enable the home to be a point of clinical service after the pandemic subsides.

In addition, Humana recently became the first national payer to take on hospital-at-home. The health insurance company is partnering with DispatchHealth to deliver in-home emergency and acute care to Humana’s 8.4 million Medicare patients.

A Promising Model for the Future

The COVID-19 pandemic has spurred a number of innovations in health care delivery that have the potential to positively alter how care is provided in the years ahead. Hospital-at-home is one of those promising models.

To support hospitals on this journey, the AHA is developing a growing body of resources. Learn more about how hospitals are launching hospital-at-home programs to improve value for their patients and community.

Julia Resnick is a senior program manager, strategic initiatives, at the American Hospital Association.