Hospital-at-home supply chain challenges

Who would have ever thought that the words “supply chain” would be used during cocktail party conversations? But thanks to COVID the term became mainstream given the difficulty in buying many of the essentials during the pandemic.  

While many shortages have largely abated, new patient care models like hospital-at-home (H@H) have broadened the scope and scale of a supply chain that brings more sophisticated high-acuity care products into the home.  

Implementing a hospital-at-home model poses several supply chain challenges, each of which must be addressed to ensure the effective delivery of healthcare services. Given that care migrates from brick and mortar wards to one where family becomes a key member of the care team, supply chain issues can have a much more emotional effect than if it were occurring in the hospital.

Key challenges to Hospital-at-home supply chain

Logistics and Delivery

 Timely Delivery: Ensuring the prompt delivery of medical supplies and equipment to patients’ homes can be difficult, particularly in remote or rural areas. 

Transportation Issues: Managing transportation logistics, including route planning and vehicle maintenance, can be complex and costly. Whereas in a hospital there are bulk deliveries that are warehoused in supply areas. In the case of H@H the deliveries are broadly distributed to a myriad of locales. I had a logistics person tell me that unexpected country road conditions had a major bearing on supplies and clinicians getting to the patient’s home.  

Inventory Management

Stock Levels: Balancing inventory to avoid both shortages and overstocking is challenging, especially when dealing with perishable medical supplies. H@H adds a whole new meaning to the well-known Just in Time inventories. 

Storage Conditions: Ensuring that medical supplies and equipment are stored under appropriate conditions during transit and at the patient’s home. This is a case where social determinants of health are seen firsthand in the residence whereas the supply chain aspects of SDOH are minimized in a hospital.  

Technology Integration

System Compatibility: Integrating various technologies (e.g., telehealth platforms, IoT devices) into a cohesive system can be technically challenging especially when the key node is in homes with a wildly diverse variety of connectivity and infrastructure.

Data Security: Ensuring the security and privacy of patient data collected through telehealth and monitoring devices. The supplies used by H@H patients can offer very intimate data point about their condition as well as how they’re being reimbursed for them whether by insurance or out of pocket. 5

Mind the Gaps: As I wrote in a recent article, one of the greatest H@H challenge is assuring a consistent and reliable flow of data across a number of members on a diverse care team that are not centered in a hospital ward.  Orchestrating the precise number of supplies, and not duplicating them, or worse thinking the other clinician has placed the order.  

Regulatory Compliance

The reimbursement landscape for H@H can be very complicated. In addition to the number of visits made by qualifying physician and clinicians, the care environment needs to meet very high-quality standards in order to qualify for reimbursement, especially through government-funded insurance.   

Partnership Management

Many providers quickly realized that H@H supply chain is not a do-it-yourself project. For this reasons most are using an integrator where everything from clinician scheduling and transportation, quality assurance, remote monitoring and supply change are all part of a central dashboard. Firms like Medically Home, Best Buy Health and Dispatch Health are but a few of the key players in that partnership space.  

Emergency Preparedness

If we learned anything from the pandemic it was how fickle supply chains can be during a natural disaster of any kind. Having an well-practiced emergency preparedness strategy for a widely distributed high acuity care in the home model is table stakes for deploying H@H, well before a disaster happens.  

This is hard work. Addressing these challenges requires a coordinated effort involving technology, logistics expertise, regulatory knowledge, and a patient/family-centered approach to care.