Can the hospital at home model revolutionize patient care delivery?

Healthcare providers and payers are continually on the search for innovative ways to reduce costs, improve outcomes, and offer positive experiences to patients. One of the best ways to meet all three goals is to keep patients out of the inpatient setting whenever possible.   

Primary and preventive care are instrumental in helping patients remain healthy enough to avoid hospitalization. But even when an acute hospital-level need arises, there are new ways to keep patients safe and comfortable in their homes without the need for expensive and disruptive admission. 

The growing availability of sophisticated virtual care and home monitoring technologies has now made it possible to deliver a much wider range of services in the home – including acute care for patients who are sick enough to need the hospital but stable enough to be safe in their own bedrooms. 

Patients largely prefer to stay home when given the option, research shows. In one study, approximately 70 percent of patients at several care sites chose a hospital at home model instead of an inpatient stay for applicable conditions.   

Thanks to this strong interest and the increasing accessibility of technologies to back it, McKinsey & Company estimates that up to $256 billion in fee-for-service Medicare expenses could shift toward the home by 2025, representing almost a quarter of the total cost of care. 

How can health systems start to capitalize on this trend and continue deliver high-quality care to patients more conveniently – and at a potentially lower cost? 

Charting the move toward virtual care and at-home services 

Delivering care at home is a significant opportunity to lower costs and free up scarce resources without compromising patient safety or quality.   

Even in 2012, before the latest generation of connected devices and telehealth tools, researchers found that the hospital-at-home model could produce lower mortality rates, lower readmission rates, and lower costs while increasing patient satisfaction and caregiver experiences. 

The COVID-19 pandemic dramatically accelerated the use of such techniques as patients became more familiar and comfortable with virtual visits for a variety of their needs. CMS notes that the share of Medicare fee-for-service visits conducted virtually rose from approximately 840,000 in 2019 to 52.7 million in 2020, although those numbers have sunk again slightly in 2022 and 2023. 

CMS specifically expanded its Hospital Without Walls program during the pandemic, creating the Medicare Acute Hospital Care at Home program to relieve burdens on overwhelmed inpatient facilities and save up to 50 percent of the costs associated with an inpatient stay. The initiative combined extensive remote monitoring with daily in-person visits from qualified nurses and integrated health paramedics to ensure patient wellness. 

Six experienced health systems were given permission to join the program immediately in 2020. Several, including Mass General Brigham, have since expanded their investment. After initiating their first hospital-at-home program in 2016 and working with the CMS program throughout the pandemic, Mass General Brigham has cared for more than 2000 patients and saved 10,000 hospital bed-days, reserving resources for the most critically ill individuals, the health system says.  

The trend is likely to continue as high-definition video visits, continuous biometric monitoring, and more portable diagnostic testing and imaging devices make it easier than ever to deliver round-the-clock observation with only limited in-person interactions with clinicians. 

Considerations for launching a hospital-at-home program 

Creating a safe and effective hospital at home program requires deep familiarity with virtual care technologies and the clinical workflows to support them. Health systems should think about the following topics and issues when considering a virtual acute care initiative: 

• Defining clear inclusion criteria for patients: Patients must be clinically eligible for at-home care. The clinical guidelines will depend on the condition at hand but should be clearly defined and regularly assessed for changes throughout the treatment process. In addition, the patient’s home environment must be suitable for hospital-level care at home. According to the American Hospital Association, the home must have running water and appropriate climate control, at minimum. Health systems will need to establish screening protocols to ensure that the environment is safe and conducive to at-home care. 
• Purchasing and integrating necessary digital tools: Architecting the digital infrastructure to support patients at home will require investment in remote monitoring devices, such as telemetry and video equipment, as well as a clear path for patient data from the home into virtual command center – and into the EHR. Working with device and services vendors that offer standards-based technologies and robust data analytics and integration services will be key for creating seamless, user-friendly workflows and infrastructure. 
• Establishing reimbursement pathways for home-based care: Virtual care reimbursement guidelines are changing rapidly as the segment advances. However, the AHA notes that many private payers do not currently cover hospital-level services delivered in the home, presenting a challenge to care providers.  Health systems will need to work closely with payers to establish contracts that cover these services and ensure that at-home care can be reimbursed at an agreeable rate.  

Learning more about the virtual care trends of the future 

With advances in technology and a greater level of experience with virtual care after the pandemic, health systems have promising opportunities to shift care from the inpatient setting to the comfort and convenience of the patient’s home. 

This movement is part of the much larger push toward virtual care, including the expansion of more traditional telehealth visits, the rise of innovative device-driven relationships, and the continued empowerment of patients through digital channels. 

It’s a complex and fast-paced segment of the digital health market, and one that is filled with pitfalls. To build a successful hospital at home program, or to further develop other virtual care and remote patient monitoring activities, healthcare leaders must invest wisely in technologies, staff, and workflows. 

To share their experience with maximizing the opportunities of virtual care, technology executives and thought leaders from around the country are coming together at ViVE in Nashville, Tennessee on March 26-29. 

Attendees can sit in on sessions addressing top-of-mind issues such as establishing a new hospital at home program and helping unpaid caregivers manage burdens during home care for their loved ones. 

Register today to join experts in the field and learn more about the latest technologies and strategies to launch a high-impact, high-quality virtual care program for hospital-at-home candidates and other patients at all levels of clinical acuity. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.