How six health systems are scaling hospital at home

At a glance

Leaders from six health systems described how they run and scale hospital at home during the virtual Hospital at Home Technology Summit. Speakers named mindset, not technology, as the biggest obstacle and pointed to clinician feedback and shared ownership as ways past it.

Hospitals in the United States are facing a crisis.

The combination of an aging population, upward trend in geographic location, and escalating costs of hospital-based care have created a perfect storm. “We have a hospital capacity and ED boarding crisis,” said Constantinos Michaelidis, MD, Medical Director at UMass Memorial Health. The growing concern, he noted, is that “we’re not going to be able to build our way out of it.”

Instead, “we’re going to have to get much more creative as we think about providing care.”

The solution that’s quickly gaining traction? Hospital at home, “an acute care delivery model that provides hospital-grade, inpatient-level clinical services inside a patient’s residence rather than a traditional physical hospital facility,” as defined by World Hospital at Home Congress.

Also referred to as healthcare at home, it offers a viable alternative to the two choices providers have traditionally faced with complex patients: keep them in hospital, where they have access to necessary services but run the risk of infection, or discharge them to the home, where support may be limited.

“We wanted to give physicians a third option,” said Gretchen Brown. Stanford Health Care, where she serves as VP and CNO, Nursing Innovation and Informatics, was among several leaders who discussed their experiences during the virtual Hospital at Home Technology Summit.

The results have been impressive. Among the metrics reported by healthcare organizations are reduced mortality and readmission rates, boosts in staff and patient experience, and improvements in access. But where it has truly made an impact is in patient care.

One patient’s story

Take, for example, the case of a 67-year-old male who presented at a UMass Memorial Health emergency department with feelings of confusion and weakness. The patient, who had high cholesterol and blood pressure, along with end-stage renal disease, left without a consultation after having waited for six hours.

When he returned, he was diagnosed with a severe urinary tract infection. This time, before he could leave, the nursing team invited him to participate in the hospital at home program (after his eligibility was determined).

Over the next 4-5 days, the patient was seen daily by nurses and physicians and received “the same acute care he would have at the hospital, including intravenous fluids, antibiotics, labs, and imaging,” said Dr. Michaelidis. Beyond that, the care team noticed subtle signs of cognitive impairment that hadn’t been previously recognized. The “medical psychosocial SWAT team” also made other critical observations — nearly a third of his medications were missing and his fridge was empty — and ensured his family was kept in the loop.

Upon discharge, the patient remained in the care of a social worker. For the next 12 months, there were no further hospital readmissions, said Dr. Michaelidis. “His care changed dramatically when we were able to witness firsthand the social determinants. And because we had insight into those challenges, we were able to address them.”

It’s the subtle difference between asking a patient, ‘are you taking your meds’ and saying, ‘show me how you take your medications,’ that can yield significant results. “We’ve seen that we can reduce long-term risks, reduce risk of going to a skilled nursing facility, and reduce readmissions.”

What these programs can do, he noted, is expand providers’ vision and offer a unique perspective on how to proceed. “We’re changing the culture of hospitals to deliver hospital-level care at home,” Dr. Michaelidis. “That’s the magic of what it can do.”

Best practices

Of course, it’s not actually magic; implementing healthcare at home models requires a significant lift from a technical and infrastructure standpoint, along with strong backing from leadership. During the Summit, leaders from a handful of systems shared best practices for deploying and maintaining successful hospital at home (HaH) programs.

Change management

As with nearly every healthcare initiative, the biggest obstacle with healthcare at home isn’t the technology piece — “it’s changing the mindset,” said Shiv Sutaria, MD, Assistant CMIO, Mass General Brigham Healthcare at Home. “This isn’t just a program to care for patients at home. This is a care delivery platform. We have to get over that hurdle.”

One way to clear it, according to Ron Li, Medical Director, Digital Health and Stanford Health Care at Home, is through awareness and transparency. And that means not just educating physicians and nurses about the program, but asking for — and, when possible, incorporating — their feedback. “It helps create a layer of trust,” he said.

Another way is through shared ownership, which is a core aspect of the HaH business model at NewYork-Presbyterian, said Maya Vankineni, MD, Senior Medical Director of NYP Hospital at Home. “When we first started, one of the most important decisions we made was to own the clinical care. We didn’t want hospital at home to feel like a separate program sitting outside of our healthcare system. We wanted it to truly function an extension of our own hospital.”

And so, they made it a point to use their own physicians, nurses, physician assistants, pharmacists, and clinical teams so that they remained “responsible for the entire care episode,” she added. “We wanted the same standards of care, oversight, escalation pathways, and the accountability that exists within brick and mortar.”

Digital strategy

One of the key building blocks of care at home, according to John Campbell, Principal, Campbell Healthcare Digital Associates, is a robust digital strategy. Organizations setting up home hospital environments, however, often underestimate the level of complexity involved.

“It’s very complicated. You need a comprehensive strategy that includes digital,” he said. Not only must solutions be in place, but they must perform as effectively as they do in the brick-and-mortar setting, despite factors such as unreliable WiFi. “Mobile changes the workflow requirements.”

For chief information and digital officers, it’s critical to be able to “articulate digital needs” in conversations with the board, and collaborate closely with clinical, operations, legal, supply chain, and other departments.

Foundation for scaling

For every organization represented at the Summit, the goal was the same: to be able to scale hospital-at-home programs to provide more services to a larger number of patients. And what most have learned is that doing so requires a solid foundation of technology, processes, and people.

“It’s exciting how quickly we’ve been able to translate our model onto a meaningful scale,” said Dr. Vankineni. Despite only starting in late 2025, NewYork-Presbyterian’s care at home model has already reached a daily census of around 12—a number her team hopes to double by next year. “It’s not about growth alone,” she said. “Our goal is to grow while maintaining the same quality and safety standards as the brick and mortar.”

One factor that has proven pivotal in that growth is integration with the emergency departments, from which 60 percent of patients are referred. “That’s been incredibly important.”

What’s also critical, according to Dr. Sutaria, is having the right people in place—and ensuring they’re on the same page. Home models, he said, “require an entirely different infrastructure around the clinical care team.”

At Mass General Brigham, that includes the admitting team and core rounding team, which consists of physicians, APPs, charge nurses, virtual nurses, paramedics, and case managers, among others. “We want to be able to care for the sickest patients,” he said. “To support that model, you need a well-rounded team.”

Emily Horvath, MD, Managing Medical Director at OSF OnCall Digital Hospital, concurred, noting that expanding often means taking on more complex cases. “There’s a personal learning curve for each provider as they learn a new model of care,” she said. “Having constant communication between our team and our colleagues in brick and mortar is what allows us to provide seamless care.”

A “moral imperative”

Of course, there are myriad financial challenges, which have been amplified by regulatory measures. And so, as organizations move forward with non-traditional models, it is imperative for leaders to be aware of policy changes and to participate in advocacy.

“Payer-agnostic care is a necessary pre-requisite for long-term AHCAH success,” said Dr. Michealidis. “Our most complex and socioeconomically vulnerable patients often do disproportionately best in AHCAH versus brick and mortar. It’s a moral imperative.”

Peter Chang, SVP and Chief Transformation Officer at Tampa General Hospital, believes care at home is “the future of medicine,” and will enable the industry to “move quicker, better, faster, and at a lower cost, while still maintaining quality and outcomes.”

For that to become a reality, however, leaders must be willing to advocate on federal and local levels and share their experiences.

“It’s so important — not only for our Medicare patients, but all of our patients,” Chang said. “They’re the ultimate stakeholder. They’re the reason we roll out bed in the morning.”

Kate Gamble is an award-winning healthcare journalist and editor with more than 20 years of experience covering healthcare IT. She has interviewed hundreds of healthcare leaders, and has focused on numerous topics, including digital transformation, patient experience, rural healthcare, physician and nursing leadership, and more. She can be reached at [email protected].