Patient-Centered Care

Health Systems Advocate for Continued Hospital-at-Home Care Delivery

Virtual care technology enables hospitals to care for patients from the home, decreasing hospital capacity and instances of patient isolation.

Donna Marbury

Donna Marbury is a journalist and award-winning social media and content strategist specializing in healthcare, technology, smart cities and culture.

After two years of shifting care models to meet patients in their home, some of the top healthcare organizations are advocating to continue reimbursement for hospital-level home care. In February, more than 15 U.S. healthcare providers formed the Advanced Care at Home Coalition to push the Centers for Medicare and Medicaid Services (CMS) for a care model that focuses on at-home care.

The coalition is compiling best practices, and points out that costs, comfort and improved care make their case for more robust home-based care. For example, a study by the Journal of General Internal Medicine found that the cost of care for at-home patients is nearly half that of hospitalized patients.

“Advanced-care-at-home programs are based on a growing body of evidence that show patients are more satisfied with their care and family stress is reduced,” says Dr. Stephen Parodi, associate executive director, The Permanente Medical Group at coalition member Kaiser Permanente. “Patient functional mobility and activity tends to be higher, and quality outcomes are the same or better than being in a hospital.”

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The Need to Continue Care at Home

Since 2020, hospital beds have been filled with patients battling COVID-19, and providers have found it safer to provide many patients with home-based care plans for a range of treatments, including infusions, skilled nursing, medications, laboratory and imaging services, behavioral health and rehabilitation services.

Dr. Pippa Shulman, chief medical officer for coalition member Medically Home, says at least 20 percent of hospitalized patients could safely be treated and monitored from their homes. Shulman adds that benefits vary based on the patient and the provider, but overall home treatment allows hospitals to safely care for more people.

“One vantage point is that hospital-at-home programs enable health systems to add capacity to their systems and care for more patients without incurring the sometimes-prohibitive costs associated with adding bed capacity inside their facilities,” Shulman says.

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Parodi says that patients with COVID-19, sepsis or pneumonia have been candidates for advanced home care with Kaiser Permanente over the past two years, and the health system has learned more about patients’ environmental and behavioral barriers and how to galvanize caretakers to address them.

“Providing acute care in the home helped combat patient isolation and loneliness, because it allowed family members to be at the patient’s bedside at home, while it also helped hospitals balance the increased demands for hospital beds,” Parodi says.

A Pathway for Increased Home Care

One of the coalition’s goals is to allow time to create a pathway for medical professionals to treat patients with safe, at-home, person-centered care for years to come, Parodi says.

“We would like to see the flexibilities issued by CMS for acute-care services at home extended beyond the duration of the COVID-19 public health emergency,” Parodi says, adding that flexibilities made possible by the Acute Hospital Care at Home waiver program are tied to the end of the public health emergency, which is currently set for mid-April.

We believe that providing this type of care is a way to improve access to safe acute and restorative care for an older population, as well as for other patients with serious or complex illnesses.”

Dr. Stephen Parodi Associate Executive Director, The Permanente Medical Group

“We’d like to see the creation of a CMS Innovation Center delivery model to test and implement a long-lasting advanced-care-at-home model, and an extension of waiver flexibilities would help to create a pathway to the model,” Parodi says. “We believe that providing this type of care is a way to improve access to safe acute and restorative care for an older population, as well as for other patients with serious or complex illnesses.”

Patients’ Expectations for Technology and Comfort on the Rise

Coalition member Mayo Clinic introduced its advanced home care model with Medically Home, which includes a web-based platform for both patients and care teams to analyze progress, says Dr. John Halamka, president of Mayo Clinic Platform.

“As a physician, I have always believed that patients should receive the right care, at the right time, in the right setting to restore wellness rapidly,” Halamka says. “During COVID-19, we’ve learned that patients expect more virtual and remote care than ever.”

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Increased technology has been essential to the expansion of home care during the pandemic, Shulman says. Medically Home provides its patients with an independent phone and phone line that directly connects them with their care team; a dedicated tablet with a single button that connects them via video to their care team; dedicated Wi-Fi capabilities; an uninterruptible power supply; and a bracelet with a button for emergency contact of their care team.

“The phone is sometimes referred to as the bat phone — it reaches only their care teams, and if it rings, the patient knows it is their care team calling,” Shulman says, adding that providing advanced care in the comfort of home has become an expectation from patients too. “Patients have come to expect the opportunity to be cared for in the home, and we need to ensure that they continue to have access.”

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