Healthcare at Home Blog Series: Hospital at Home Programs
Hospital at home programs have proven effective in reducing complications while cutting the cost of care and improving patient outcomes
THE VBP Blog
The Hospital at Home (HaH) concept was developed long ago but did not gain much traction in the United States until the COVID-19 pandemic struck. Despite being adopted out of necessity during the global health crisis, experts believe that the programs are here to stay.
Hospital at Home programs allow patients to receive in-patient hospital-level care from the comfort of their own homes. Through these programs, patients get daily supervision by doctors, access to IVs and prescription medication, among other services. These programs have shown to be successful, leading the implementation by many health systems across the country.
CMS Expanded Hospital at Home Access
In the midst of the COVID-19 pandemic, in April 2021, the Centers for Medicare and Medicaid Services (CMS) launched a new program that expanded hospital at home care across the country. The Acute Hospital Care at Home Program was an expansion of their Hospital Without Walls initiative that launched in March 2020 to combat COVID-19 and manage inpatient beds.
Under the program, Medicare beneficiaries receive home-based care for over 60 acute medical conditions. These conditions include congestive heart failure, asthma, pneumonia, among others. The goal is to provide hospital-level care to acutely ill individuals from the comfort of their own homes.
As of April 16, 2021, 56 health systems and 127 hospitals across 29 states have been accepted in the CMS Acute Hospital Care at Home Program. There is still continued interest from other health systems in hospitals on joining the program.
Johns Hopkins Hospital at Home Model
Johns Hopkins was one of the pioneers of the Hospital at Home model in the United States. What started as a 17 patient pilot trial in 1996, transformed into a national study of three Medicare-managed care organizations from 2000 to 2002. This then led to a larger expansion. In 2011, the hospital system helped Clinically Home, a healthcare startup, develop a home-based care model that relies heavily on telemedicine and has since grown to a heavy national presence.
The expansion was due to the initial success of the program. Compared to similar hospitalized patients, HaH patients experienced lower rates of mortality, delirium sedative medication use, and restraints. They also experienced better satisfaction of patient and family, lower caregiver stress levels, and better health outcomes. The John’s Hopkins Hospital program also saw a 32% reduction in costs compared to hospitalized patients.
“Hospital at Home is an excellent model of care that can be implemented in a practical way by health delivery systems across the country and can have dramatic positive clinical and economic outcomes for patients and systems,” says Bruce Leff, M.D., the Johns Hopkins professor who developed the Hospital at Home model stated.
With strong success, the Johns Hopkins Hospital at Home program was implemented by health systems across the country.
Presbyterian Healthcare Services Expansion
Presbyterian Healthcare Services utilizes the Johns Hopkins model. They launched their program in 2008 and a 2012 published study showed that Medicare Advantage and Medicaid patients treated through HaH had similar or better health outcomes than inpatients. The study involved 323 patients that chose the Hospital at Home program and their results were compared to 1,048 hospital inpatients. In addition to reduced costs, the yearlong study showed slightly lower hospital readmission and mortality rates, and almost 10 percent higher patient satisfaction scores.
Patients can enter the program through three routes: they arrive at the Emergency Department, they are referred from the community, or they are transferred into the program from the hospital. To be eligible, patients must have a diagnosis on an approved list of conditions that can be managed properly through the Hospital at Home program, among other requirements.
With strong results and a solid foundation utilizing the John Hopkins model, the Presbyterian Healthcare Services HaH program is expected to continue to expand.
Mount Sinai HaH Program
Mount Sinai also launched a Hospitalization at Home program in 2014. The integrated eight-hospital health system based in New York City did this after receiving a $9.6 million grant from the CMS Innovation Center.
The health system saw similar results as other systems across the country. Patients participating in their Hospitalization at Home program saw an 8.6% 30-day readmission rate, compared to 16.1% for similar hospitalized patients. Those with home-based care also saw fewer emergency department visits and experienced better patient satisfaction.
In November 2020, Mount Sinai was one of the first sites to qualify for a waiver through the CMS Acute Hospital Care at Home program. This allowed them to receive the full hospital-level diagnosis-related group payment for services provided at home. However, when the CMS demonstration ended, Mount Sinai had to pivot to receiving payments through other payers like Medicare Advantage plans and commercial plans. This proved complex and reinforced the importance of having a payer to promote the expansion of home hospital programs.
Advocate’s Perspective
While the Johns Hopkins Hospital at Home program is the most widely used in the country, other models are being rolled out. Both the Mayo Clinic and Intermountain Healthcare rolled out their own unique models in recent years and results have shown, like prior studies, that HaH programs are beneficial to consumers. Coupled with the CMS expansion of the Acute Hospital Care at Home program, there are promising signs that Hospital at Home programs are going to expand. This is good news for the aging population and those with acute health issues as they can receive equal or better hospital-level care, at a lower cost, from the comfort of their home. However, we need to ensure that value-based payment models are in place to incentivize quality care and continue the expansion.
In the next blog, we will take a deeper look into organizations that are expanding in the healthcare at home arena and the various initiatives they are undertaking.
Onward!
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.