Nov 27 2023

Why Healthcare Leaders Hope to Keep Their At-Home Acute Care Programs

A federal waiver during the public health emergency allowed many healthcare organizations to stand up services that ultimately improved patient outcomes.

At hundreds of hospitals across the U.S., patients now have a choice: heal onsite or at home.

“When we offer our home hospital option to patients admitted in our hospital who meet safety criteria, about 70 percent of people say yes and 30 percent say no,” says Dr. Constantinos Michaelidis, medical director of UMass Memorial Health’s hospital-at-home program.

At-home acute care services are now offered by nearly 300 hospitals and 37 states, according to the Centers for Medicare and Medicaid Services. Availability has boomed in recent years, largely due to the federal waiver during the COVID-19 pandemic that allowed hospitals to provide staff, services and health monitoring to patients at home. Legislation and funding to support these services were recently extended through 2024.

The waiver was needed desperately during the public health emergency as hospitals quickly ran out of room for patients. But even after the PHE expired, hospital capacity remains an issue.

“It’s not uncommon for us to have 50 or 60 patients who require inpatient admission waiting for beds in our emergency department,” Michaelidis says. “I strongly believe, based on our program data, that for appropriately selected clinical conditions and acuity that the hospital-at-home services we have now are safer, more effective and lead to better patient outcomes than the brick-and-mortar hospital.”

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At-home acute care is for short-term conditions — such as broken bones, post-surgery recovery or other illnesses — that might typically be managed by in-hospital care.

“Essentially, it’s a level of care above traditional remote monitoring that adds services that would have been delivered in the hospital: occupational or other therapies, nurse visits, nutritional services and so on,” says Rob Havasy, senior director for connected health at the Healthcare Information and Management Systems Society.

Unsurprisingly, these services rely heavily on technology to be successful.

“The technology ranges from devices that track the most basic physiological measurements, such as blood glucose, blood pressure and weight,” Havasy says. “Tablet devices were a real breakthrough. They allowed patients to talk to providers about qualitative symptoms, which may be equally or more predictive than physical measurements.”

The Focus on Health Equity and Quality with At-Home Acute Care

UMass Memorial Health cares for predominantly medically underserved populations in central Massachusetts, Michaelidis says, so designing the program for health equity from the start was critical for success.

So far, the outcomes have been excellent. “We’ve served about 1,500 patients since we took in our first patient in August 2021,” he adds.

Within the first two years of the program, there was an 80 percent to 90 percent drop in patients transferring to nursing homes after a hospital-at-home stay, according to a report by The Boston Globe. The program also found that patients were more satisfied and had lower mortality and hospital readmission rates than patients admitted to the brick-and-mortar hospital.

Once a brief survey helps determine that a patient candidate is a good fit for the program, the patient is transferred to his or her home and met by members of a dedicated mobile nursing team that sets up tablet and health monitoring devices (and a Wi-Fi hotspot, if needed) that are used for telehealth visits.

“Patients have instant access to their care team 24/7,” Michaelidis says. “There’s an ‘I need help’ button on the tablet that connects with a nurse right away, and medical professionals can be at the home in minutes.”

DISCOVER: What’s the future of at-home acute care?

Armbands with sensors transmit heart rate, oxygen level, respiratory rate and skin temperature, which are all continuously monitored in the background by a virtual nursing team.

In the home, patients receive a nurse visit at least twice daily and communicate with a physician via the tablet daily or more often as needed. Other services can include hospital food deliveries and occupational and physical therapy.

Michaelidis credits the federal waiver for the funds to launch and run the program. He is concerned that if the waiver expires after 2024, these promising outcomes will vanish.

“The program gives the patient and family a higher comfort level,” he adds. “When people know the program because they had been previously admitted to it, they ask for it right away in the emergency department. They ask to go home with the hospital-at-home care team.”

Dr. Stephen Harder
That one change probably saved about 30 hospital days. He’s now able to go home and spend time with his kids instead of being in a hospital bed.”

Dr. Stephen Harder Medical Director, Parkland Hospital at Home

Why Improving Digital Literacy Is Crucial

Dallas-based Parkland Health is one of the largest public hospital systems in the country. Its at-home acute care program, launched in 2022, has already reached a major milestone.

“In a year and a half, we’ve created 1,214 additional bed days for the hospital,” says Alissa Tran, director of acute care at home for Parkland Hospital at Home.

Initially, Parkland Health staff screened patients manually for the at-home program, but quickly streamlined the intake process.

“We worked with the Epic team to develop screening tools to identify patients,” says Dr. Stephen Harder, medical director of Parkland Hospital at Home. “We look at the medical record in addition to their ZIP code, the payer mix and living conditions.”

Similar to UMass Memorial Health, Parkland Health cares for vulnerable populations, so the program takes patients’ specific needs into consideration.

RELATED: Remote patient monitoring plays important role in advancing home healthcare.

“Many of our patients live in digital deserts, where reliable and affordable internet is lacking and access to specific devices is problematic,” Tran says. “Some have relatively low digital literacy, which often coincides with lower health literacy. So, to really function, our program has to overcome those barriers.”

The program does this in a number of ways, from installing Wi-Fi in the home to providing simple tablet devices that are “as easy to use as a phone,” Tran says. Staff members provide training on the devices, particularly the tablets that patients use to connect with their care team.

“We’re educating our patients once or twice daily on how to use the device, how to answer video visits or initiate video visits. This may be the first time they’ve done that,” Tran says.

Working with patients inside their homes helps identify other problems that can improve quality of life. In one experience, Harder says, a care team that was managing a patient with multiple chronic conditions identified that he should get a special lift to help him get in and out of bed, and they worked with him to obtain that equipment.

“That one change probably saved about 30 hospital days,” Harder says. “He’s now able to go home and spend time with his kids instead of being in a hospital bed.”

Providers Gain Much-Needed Insight to support Holistic Health

On the West Coast, Dr. Vivian Reyes, an emergency room physician by training, initially wasn’t convinced that acute care at home was effective for patients. As her role expanded to include strategic operations at Kaiser Permanente in Northern California, her viewpoint changed.

“I was involved in several large-scale projects that enhanced the patient experience in the hospital space. My involvement moved my eye toward the hospital-at-home concept as we recognized that, not just at Kaiser Permanente but across the country, patients were getting sicker, their care needs were more complex and they wanted more on-demand care. They wanted to get care in their home,” says Reyes, who is now the national physician lead for Kaiser Permanente Care at Home.

After a small pilot program, Kaiser partnered with Medically Home to provide the operational and technology infrastructure to build an at-home acute care program. Patients receive biometric tools and an easy-to-use tablet. Cradlepoint hardware provides connectivity, if needed.

$265 billion

The estimated amount spent on care services at traditional facilities that could be redirected to acute at-home care by 2025

Source: mckinsey.com, “From facility to home: How healthcare could shift by 2025,” Feb. 1, 2022

“We also have a help button that we place strategically in the home — in the kitchen or the bathroom, for example — that connects to the care team immediately,” Reyes says.

Interoperable software works behind the scenes to connect physician services and medical records with requests for lab work, pharmacy needs and even couriers to make the logistics of home healthcare run smoothly.

“The beauty of this program is that we designed it from scratch, and we designed it around the patient,” Reyes says. “Because we have eyes in the home and see the patient, we can also see the barriers to providing more robust healthcare. We can see the issues that have been preventing them from getting good care, and we can solve them.”

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