Patient-Centered Care

HIMSS22: 4 Considerations for the Future of Hospital-at-Home Programs

Healthcare leaders anxiously look ahead to what acute care for patients in the home will look like after the public health emergency.

Teta Alim

Teta Alim is the managing editor of HealthTech. Teta previously worked as a digital journalist in Washington, D.C.

A healthcare model for providing acute care for patients in the comfort of their homes, hospital-at-home programs have been used for decades in the U.S. Pioneered and trademarked by Johns Hopkins University, these programs have grown over the years and expanded rapidly during the COVID-19 pandemic.

That’s in large part due to a waiver from the Centers for Medicare and Medicaid Services for acute hospital care at home, with some 92 systems and 203 hospitals in 34 states approved as of early March. “If you would have asked me in November [2020], what’s the number of hospitals that would go after Hospital-at-Home waivers [USA CMS], I think folks would have said maybe 40 on a good day and we’re up to over 186! And more are applying,” said Dr. Bruce Leff, who led the initial hospital-at-home study and model at Johns Hopkins, in the HIMSS paper “Crisis as a Catalyst for Innovation,” which studied the program in different systems.

According to HIMSS researchers, studies suggest that at-home care leads to better outcomes for patients and costs up to 30 percent less to provide than traditional in-person care. In-home hospitalizations can also save $5,000 to $7,000 per episode.

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However, the CMS waiver is expected to expire at the end of the public health emergency, which has been extended throughout the pandemic and is up for consideration in mid-April.

Experts at HIMSS22 discussed the concerns about and benefits of hospital-at-home programs, and they offered insight into how healthcare organizations can move forward amid uncertainty.

1. Reimbursement Needs to Change

“If we don’t get to some kind of equitable payment system, hospitals have very little incentive to support these programs because they’re basically taking patients out of their inpatient beds and then getting paid less for care in the community,” said Joel Reich, adjunct faculty member at the University of New Haven and Jefferson College of Population Health, during a HIMSS Digital session.

The shift from a fee-for-service to a value-based payment model will need to happen, especially since providing acute care to a patient at home truly represents a person-centered healthcare model, added Joan Imrich, director of advanced analytics at Johnson & Johnson.

Though some payers, such as Humana, offer to connect their members with acute medical services at home, all eyes will be on Capitol Hill and CMS to make the change permanent. After all, when CMS leads, commercial payers will usually follow.

“Hospital at home is an exciting concept,” Imrich said. “It’s more than a trend. We see that it holds promise for achieving all components of the Quadruple Aim and potentially reducing health disparities.”

From left to right: Moderator Ian Hoffberg, HIMSS Program Manager, introduces speakers Joan Imrich, Director of Advanced Analytics at Johnson & Johnson, and Joel Reich, Adjunct Faculty Member at the University of New Haven and Jefferson College of Population Health, during the session “Is the Future of Healthcare Coming Home?”

2. What’s the Movement on Capitol Hill?

Restructuring the payment model for hospital-at-home programs would have a major effect on sustaining momentum beyond the pandemic.

Much like the expected “telehealth cliff” that looms if legislation doesn’t codify pandemic-era changes, the hospital-at-home waiver will need an act of Congress to survive. The latest bill introduced this month, the Hospital Inpatient Services Modernization Act, would extend the waiver program for two years after the end of the public health emergency.

“These hospital at home programs have been and continue to be reliable and impactful vehicles to deliver effective care, lead to high patient satisfaction, and, for some patients, result in shorter recovery times,” the American Hospital Association said in a letter to the House and Senate bill sponsors. “As you consider action beyond the two year waiver extension set forth in your legislation, we would welcome the opportunity to work with you and CMS to establish and implement a permanent version of the program that enables qualified patients to receive safe and effective hospital-level care in the comfort and safety of their home.”   

The recently formed Advanced Care at Home Coalition, which includes founding members Mayo Clinic, Medically Home and Kaiser Permanente, is also advocating for continued flexibility in hospital-at-home programs across the country.

3. Keep Patients at the Center

There are still many questions about identifying eligible hospital-at-home patients, data reporting, and measuring a program’s quality, outcomes and patient satisfaction, Reich said.

So far, Imrich said, studies have found that hospital-at-home programs can lower readmission rates and promote greater patient satisfaction. And by seeing patients recover at home, clinicians have more insight into factors in their daily lives that can affect their health.

Barriers such as interoperability, broadband connection and weak digital literacy could hamper wider patient adoption. “Moving care safely out of a billion-dollar high-tech hospital and into a bunch of people’s homes is no small feat,” Imrich added.

4. Provider Buy-In and Satisfaction Are Also Crucial

Healthcare organizations need to be aware of “shiny object syndrome,” said John Glaser, executive in residence at Harvard Medical School. “People install this stuff and spend a lot of money on the stuff, but they don’t actually leverage it or really work it to gain organizational improvements. You have to remember: You buy organizational improvement, you don’t buy software. Sometimes people forget that.”

From left to right: Moderator Casey Ross, National Technology Correspondent at STAT News, listens to speakers Jodie Lesh and John Glaser during the session “How Can Transformation Lift Patients, Populations and Outcomes?”

The pandemic, paired with accelerated digital transformation, has been an incredibly challenging time for providers, and burnout is prevalent, added Jodie Lesh, chief transformation officer at Kaiser Permanente. Programs should explore ways to improve workflows and reduce the burden for providers.

Providers are also not a monolith: One may be tech-savvy and ready to adopt new tools, but another may be more hesitant. Their trust and reliance on a hospital-at-home program is imperative.

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