Hospital at Home: A Valuable Tool for Transformation
Strategic Planning, Healthcare Transformation, Business & Financial Planning, Payers & Payment Models
It’s rare that an emerging delivery model can show immediate progress on three of the measures that matter most in healthcare transformation: better outcomes at lower cost with higher patient satisfaction. If this is the “healthcare trifecta,” the emerging Hospital at Home model may be one of the most promising trends in many years – yet it rarely gets a mention in most boardrooms or strategic planning documents.
Hospital at Home is an alternative care delivery model that provides acute care in the home rather than in the inpatient setting. Each program operates a little differently, but all programs assess whether a patient matches certain criteria that would make them a good candidate for treatment in the home. Patients receive at least daily visits from healthcare providers either in person or via telehealth, and their vitals are monitored closely.
The Hospital at Home model first showed widespread promise in countries like Australia where payment incentivizes delivery innovation. Until the Covid-19 pandemic, payment in the U.S. was a challenge as most payors, including CMS, did not reimburse for Hospital at Home services. However, CMS issued a waiver in March of 2020 that allowed hospital systems to be reimbursed for acute care services performed in the home. Now, over 50 hospitals are approved and some of those are developing programs for the first time. Many of the participants are in metropolitan areas and associated with larger healthcare systems, but some are small hospitals in rural areas.
Although the Hospital at Home model is still relatively new in the U.S., early adopters have reported encouraging data on all three measures of the healthcare trifecta.
DELIVER HIGH QUALITY CARE
Studies have shown a dramatic improvement in outcomes when comparing Hospital at Home to traditional inpatient services. A three-year case-control study conducted at Mount Sinai Health System in New York found that metrics were consistently better for patients enrolled in Hospital at Home. [1]
[Note: Control patients met Hospital at Home eligibility criteria but refused participation or were seen in the ED when a Hospital at Home admission could not be initiated. Hospital at Home patients were older than controls, less likely to have a college education, less likely to have Medicare Advantage or private coverage, and more likely to have 1 or more pre-acute functional limitations. There were no significant differences by sex, race or ethnicity, or self-reported pre-acute general health.]
Similarly, a randomized control trial conducted at Brigham and Women’s hospital last year found that 7% of patients receiving acute care at home were readmitted within 30 days versus 23% of traditional patients. [2] Of note, the traditional patients in the control group were clinically eligible for home care but either chose traditional inpatient care or were admitted when Hospital at Home could not be initiated.
REDUCE COSTS
Healthcare costs continue to rise faster than both wages and inflation. As payment continues to change and evolve, many hospital-based procedures will be forced to move outside of the hospital to decrease costs. One of the first Hospital at Home programs was developed by Johns Hopkins; it was initially meant for elderly patients who refused to be treated in the hospital or were susceptible to hospital-acquired infections. A pilot study of the program found that costs were reduced by 47% when compared to more traditional inpatient treatment. [3] Significant cost reduction has been observed in many case studies, as shown in the chart below.
[Note: Presbyterian Healthcare Services [4]]
INCREASE PATIENT SATISFACTION
With rising prices, increases in cost-sharing, and new price transparency laws, patients will continue to demand more from their healthcare. The Covid-19 pandemic has likely accelerated this trend as patients have become more accustomed to convenient care. Hospital at Home programs provide a comfortable experience for the patient, leading to higher overall satisfaction rates. Mount Sinai Health System modeled their Hospital at Home program after the Johns Hopkins model and found that patients in the Hospital at Home group gave satisfaction scores that were almost 25% higher on average than comparable inpatients (68.8% vs. 45.3%). [1]
As healthcare transforms, Hospital at Home will be a more cost-effective solution to inpatient care. The explosion of telehealth during the pandemic will likely benefit Hospital at Home. Multiple bills to expand access to telehealth services, like the CONNECT for Health Act, have been introduced/reintroduced this year, and many of these bills propose reimbursement in the home setting. This alternative acute care model is a proven, effective method to reduce cost, increase quality, and delight patients.
Only time will tell how the Hospital at Home model will evolve in the future, but given the encouraging data, we expect to see widespread adoption. Early movers are likely to gain the greatest advantage, so forward-thinking leaders may want to incorporate Hospital at Home in their strategy discussions now, while the approach is still new and noteworthy.
Sources:
[1] https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2685092
[2] https://www.acpjournals.org/doi/10.7326/M19-0600
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