Making the Acute Hospital Care at Home Program work for health systems

The Acute Hospital Care at Home Program has made significant strides since it was first introduced in November 2020 as an expansion of the Hospitals Without Walls program. As of Feb. 3, 201 hospitals in 91 health systems operating in 34 states have been approved. The Mayo Clinic has said the program has freed up 3,300 hospital bed days at its hospitals in three states.

The program began to help hospitals focus on treating patients with COVID-19 onsite, maintain the capacity to care for non-COVID patients outside the hospital setting, and continue being reimbursed as if those patients were within the hospital. Increasingly, though, organizations see care at home as a critical component of addressing the Quadruple Aim, said Natalie Schibell, a senior analyst at Forrester.

“Patients naturally heal better at home, around their caregivers and loved ones and pets. They have access to the foods they like. That puts them in a positive mental state,” she said. In addition, being at home reduces the risk of falls as well as hospital-acquired infections, which contributes to better clinical and financial outcomes.

Most of the technology required to support care at home is familiar to clinical and IT leaders: Virtual visits, remote patient monitoring, and alert systems, along with the infrastructure to host the applications and the security tools to keep data safe.

Unlike other care management programs, patient identification won’t require heavy lifting. CMS has set strict eligibility criteria, Schibell noted, as patients need to have a caregiver at home and have stable vital signs.

One important consideration is ensuring that patients at home have adequate internet access, whether it’s to transmit a packet of biometric data or to alert a care manager that they aren’t well. Some organizations have been providing “boosters” that increase bandwidth, but they’ll have to consider whether to keep these devices in place after a patient completes a program and care at home is no longer being reimbursed, Schibell noted.

Another consideration is coordinating data sharing among care professionals in the hospital and the ancillary providers who may visit a patient in the home. Many hospital-at-home vendors have developed their own applications so home care workers can capture notes and other information, which is then fed into hospital EHR systems on the back end. IT leaders will have to explore their options here to ensure that accessing data from providers at home doesn’t disrupt workflows within the hospital.

The biggest operational challenge, Schibell said, may be increasing volume – especially if hospital culture tends to emphasize keeping a watchful eye on patients. To reach a broader patient population and work out any possible kinks in program implementation, she recommended starting with low-acuity patients before progressing to those with high-acuity conditions.

In any case, Schibell said, now is the time to invest in care at home: “In the next five years, if hospitals aren’t on board, they won’t be relevant.”

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.