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Hospital at Home: Answering the $30,000 Question

Portrait of Dawn Carter

Dawn Carter

An IV bag is isolated on a blue background. Because we can't determine the location, the photo illustrates the versatility of Hospital at Home programs.

If you’ve been working remotely for the past year, would a $30,000 raise entice you back into the office? In a recent survey of 3,000 workers at dozens of large US companies, the vast majority of respondents said they would forego the hefty raise if they could keep working in their pajamas.

I’ve spent more than 25 years in healthcare strategy and planning, and that was one of the most remarkable surveys I’ve ever seen – though not in terms of HR, because healthcare is one of the few industries where remote work never took hold during the pandemic.

Instead, I think the urgent lesson for healthcare planners is all about how – and where – services will be delivered in the future. Call it “the Covid effect”: In the same way that employees over the past year discovered the advantages of working at home, we’ve seen a huge number of new patients who discovered the advantages of so-called Hospital at Home programs.

Hospital at Home is not exactly a new model, but it’s been relatively unknown among patients until now. That’s because limited, early experiments suffered from low participation rates – just 7 to 15 patients per month. But those numbers got a huge boost over the past year as hospitals scrambled to preserve in-patient capacity for only the most extreme Covid cases.

The Association of American Medical Colleges says interest in Hospital at Home “exploded” during the pandemic, and health systems from Boston to Cleveland to Seattle launched or expanded in-home programs that served thousands and thousands of new families.

It may be hard to put this genie back in the bottle. If workers won’t go back into the office for $30,000 what could possibly entice patients back into the traditional hospital setting once they’ve experienced the benefits of healing at home?

At Ascendient, our Healthytown model assumes that consumerism is driving healthcare transformation to a greater degree than most planners realize. From banking to retail, consumers have shown that they will shift their spending to providers who can meet their needs from the comfort of home. Some healthcare planners may believe they are immune to this trend because healthcare services can only be delivered in a clinical setting, but Hospital at Home has proven that’s not true – and consumers, for the first time, are beginning to understand their options.

The Hospital at Home Trifecta

As more and more patients actually experience the benefits of healing at home – quiet rooms, home cooking, better sleep, more time with family and pets – we project demand will grow. Just as many workers are saying they will never go back to the full-time, in-office routine, we expect to see rising resistance to inpatient admission from those who understand the alternative.

For the forward-thinking healthcare executive, this is a chance to re-think assumptions. Just as Covid proved that working at home could be a win-win for many businesses, we now understand that healing at home can be a win-win-win for hospitals: In addition to higher patient satisfaction, the model offers better health outcomes along with reduced costs for the healthcare system. That’s a rare trifecta, indeed.

From readmissions to time in bed, many studies have shown that patient outcomes are better under the Hospital at Home model. Take the key metric of 30-day ED visits, for instance. At New York’s Mount Sinai Health System, ED visits for in-home patients were cut roughly in half compared to patients admitted to the hospital (5.8% vs. 11.9%). And UnityPoint Health in West Des Moines, Iowa, got its 30-day ED rate down to just 4% for in-home patients – while boasting a satisfaction rate of 98.9%.

As for costs, the data are just as encouraging. In a long-running program at Johns Hopkins, studies found that total costs for at-home patients were nearly a third less than inpatient care ($5,081 vs. $7,480). In Albuquerque, NM, Presbyterian Healthcare Services adopted the Johns Hopkins model and saw costs drop by 19% for Medicaid and Medicare Advantage patients while reporting similar or improved outcomes.

With so many selling points, the Hospital at Home model looks certain to gain traction in the wake of the Covid-19 pandemic. But here’s one more reason we believe the strength of the trend may yet be underestimated: In markets with multiple providers, the first to offer Hospital at Home services may find itself with a rare competitive advantage.

From technology to readmission rates, consumers have a hard time understanding some of the more esoteric benchmarks that distinguish one hospital from another. But the chance to get top-quality medical care in the comfort of one’s own home? That’s something any consumer can understand. Like roadside billboards that display ER wait times, a robust menu of hospital options at home could be the easy-to-understand brand distinctive that motivates some consumers to choose Hospital A over Hospital B.

In short, we see Hospital at Home as the emerging trend most likely to literally re-draw the map of healthcare delivery in many communities. That makes it a trend no CEO can afford to ignore.

This opinion was originally published in The Health Care Blog