Care at home study shows positive results for Medicaid patients

Researchers at two Massachusetts health systems are touting the long-anticipated results of a study that indicate an acute care at home program can yield positive clinical outcomes for patients on Medicaid. 

The results could lead to payer support for a program that aims to reduce hospital bed days and length of stay and give more patients an opportunity to receive care at home instead of in a hospital. 

The study, conducted by Mass General Brigham and UMass Chan Medical School and recently published in the Journal of the American Geriatrics Society, found that the care at home program led to low readmission rates and few discharges to skilled nursing facilities, as well as very few mortalities.  

“We are excited to now have an evidence base that shows home hospital is effective for patients with Medicaid,” David Levine, MD, MPH, MA, clinical investigator and Medical Director at Brigham and Women’s Hospital and Harvard Medical School and lead author of the study, said in a LinkedIn post from Mass General Brigham Research. “We should see Medicaid agencies across the country adopting this evidence-based practice.” 

Often called Hospital at Home, the strategy gained national prominence during the COVID pandemic as a means of reducing hospital overcrowding. Much of that growth was tied to a waiver enacted by CMS during the pandemic to enable health systems and hospitals to receive Medicare reimbursement if they followed the strict guidelines of the Acute Hospital Care at Home (AHCaH) program. 

More than 350 AHCaH programs are now up and running, supported by an extension of the waiver until September 2030. Many other health systems and hospitals are experimenting with different versions of the care at home model, in the hope that these programs can be sustained without CMS support.  

Advocates hope this study and others can convince federal authorities not only to make Medicare coverage permanent, but to relax some of the guidelines around AHCaH to enable more programs to qualify. As well, supporters are hoping the result will encourage private payers to support the strategy. 

For the study, researchers tracked Medicaid patients at three academic medical centers and one community teaching hospital in Massachusetts from November 2020 through September 2023, covering 906 AHCaH episodes. The most common diagnoses for these patients were heart failure (14%), septicemia (11%) and respiratory infections (9%). The median age of patients in the study was 65, while 60% were female, 40% were male, , 48% were white, 37% were Hispanic, 38% only had Medicaid coverage and 62% were dually eligible for Medicaid and Medicare. 

The potential of the care at home model lies in enabling health system and hospitals to shift more services from the hospital to the home, where studies have shown that patients are more comfortable and heal more quickly. Opponents argue that the program is too complex and costly and disrupts the patient’s home. 

In a recent interview, Constantinos ‘Taki’ Michaelidis, Medical Director of the Hospital at Home program at UMass Memorial Health and a member of the study’s research team, noted that health systems and hospitals are particularly interested in programs that can reduce costs and boost outcomes for the Medicaid population. Many states are under pressure from the federal government to reduce Medicaid expenses and remove people from Medicaid eligibility.