Home Health Series – How Hospital at Home is Revolutionizing Patient Care
The Rise, Benefits, and Key Players of Home-Based Hospital Care
THE VBP Blog
September 13, 2023 – The evolution of healthcare delivery is undergoing another transformative shift. A rapidly emerging model, aptly termed hospital at home, is reframing the very core of hospital-based care. As healthcare systems and stakeholders grapple with the challenges of capacity, cost, and patient satisfaction, solutions that cater to the patient’s comfort, while not compromising on the quality of care, are increasingly in demand.
The hospital at home model moves patient care away from brick-and-mortar hospitals and into the comfort of their home. It’s a delivery model that is designed to lower costs and improve patient experiences, but also opens avenues for efficient, effective, and extended healthcare delivery. Keep reading the third blog in our Home Health Series for an in depth look at the hospital at home model, how it is revolutionizing patient care, and what it shows us for the future of healthcare delivery.
What is Hospital at Home?
The hospital at home concept is a care model that allows patients to receive hospital-level care in the familiar settings of their own homes. Rather than being admitted to a brick-and-mortar hospital, qualified patients are provided tailored healthcare services, medical equipment, and the necessary support in the comfort of their own home.
Why does this model work? Studies show that the comfort and familiarity of one’s own home can potentially expedite recovery, reduce the chances of hospital-related complications, and significantly enhance patient satisfaction. Furthermore, it presents a cost-effective alternative to traditional care because there is less overhead and a reduced need for infrastructure. In essence, hospital at home programs combine the best of both worlds – the robustness of hospital-grade care and the personalized touch of home-based services.
It is important to note that hospital at home programs do not work for all patients, as there are many situations where care in a brick-and-mortar hospital cannot be safely and efficiently delivered in a home setting. These programs are designed for patients with qualifying acute conditions, such as congestive heart failure, pneumonia, chronic obstructive pulmonary disease, and other acute conditions that have defined treatment protocols.
Existing Hospital at Home Programs in the U.S. and Their Results
Hospital at home programs are not a new concept, but have been thrust into the spotlight as they gained traction across the country partly due to the COVID-19 public health emergency. The question is, while their intentions are good, do these programs actually produce the desired results that benefit consumers?
Johns Hopkins pioneered its Hospital at Home program with impressive outcomes. Compared to traditional hospital care, their program displayed many benefits. Patients in this program experienced fewer complications and better health outcomes, such as shorter stays and reduced readmissions. The program has also seen cost savings between 19% and 30% when compared to traditional inpatient care. The program also led to lower stress levels for caregivers and even better functional outcomes for the patients.
Commonwealth Fund research offers a broader perspective on hospital at home programs. Across the United States, well-monitored, at-home treatment has consistently proven it can be safer, cheaper, and more effective than traditional hospital care. Another study published by the National Library of Medicine showed similar findings of shorter length of stay, fewer readmissions, better clinical outcomes, and lower cost of care.
Let’s be honest. No one enjoys being hospitalized. The constant bustle of the hospital reduces the ability to rest and for older patients, being outside of their home can cause confusion as well as feelings of isolation. But the examples above underscore that the hospital at home model, when executed effectively, can offer high-quality care, cost savings, and an enhanced patient experience.
Hospitals and Home Health Agencies Building Their Own Programs
It comes as no surprise that traditional hospitals are also launching their own programs. We’ve detailed the Johns Hopkins program above, but that is not all. Other hospitals like Mount Sinai in NY, Mayo Clinic in Florida, and Cleveland Clinic have their own programs. Kaiser Permanente also has several facilities in Oregon, among others. In fact, 296 hospitals in 37 states offer acute care at home and that number is growing.
While hospitals are rolling out their own programs, there are others, like home health agencies set up with most of the infrastructure in place to deliver these services. For example, Baylor Scott and White Health, the largest not-for-profit health system in Texas, and Contessa, a top high-acuity home care provider are rolling out a program to provide continuum of care in the home. This will include new alternative care models to extend comprehensive, coordinated medical care to patients’ homes, including hospital-level care, palliative or supportive care, and skilled nursing care. Partnerships like these suggest a potential future where traditional hospitals and home care or home health agencies collaborate to bring the best of both worlds to patient care.
Many HHAs suggest that they can provide care for acutely ill patients at home for significantly less than hospitals can. In essence, they believe they can deliver high-quality care while saving costs, mainly by leveraging existing infrastructure and reducing overhead. Hospital at home programs require patient volume and teams that can immediately access and deliver needed care including diagnostics, monitoring, pharmaceuticals, and nursing services. It also requires physicians to work closely with home-based care providers and coordination of care, as well as prompt patient intake. These are all capabilities that most home health agencies have already, which could make them a good fit.
However, critics question the ability of these agencies to handle acute patient needs without further training and investments. This is especially a concern due to current staffing issues facing the home health industry. There is no doubt that home health agencies would need to scale up infrastructure, including expanding staff, but overall, they are ideally suited to partner with hospitals to provide acute services in the home.
Private Equity and Venture Capital Flocking to Hospital at Home
The hospital at home model is seeing a surge of interest, not just from traditional hospitals building their own systems and home health agencies, but also from Venture Capital (VC) and Private Equity (PE) firms.
A pivotal driver behind the influx of PE and VC firms into the hospital at home market is the potential for a continuous revenue stream from patients, supported by health IT platforms that they also own and develop. These firms aim to offer an entire suite of services that address the full continuum of care so patients experiencing one issue in their system can become a long term “client” so to speak. The incorporation of telehealth technologies further enhances the viability of these services.
Several players, both new and old, are making moves in the hospital at home space. AccentCare, backed by PE firm Advent International, is not only exploring new technologies but has also partnered with academic institutions like the University of California San Diego for hospital at home services. Other entities like Dispatch Health and MedArrive are also making strides in the hospital at home domain, utilizing a blend of telehealth, mobile healthcare, and partnership models.
But while these partnerships and technological advancement are happening, we need to make sure that delivering high-quality care and consumer choice remains at the forefront when PE and VC firms come into the mix. This is why the hospital at home model has some critics. Concerns revolve around the replacement of Registered Nurses with lesser-trained staff and potential fraudulent billing practices. The overarching fear is that the push towards reducing costs may compromise patient care.
In addition, some of these private programs triage patients before they leave this home to decide whether they need to see an ER doctor or whether they can be treated at home. This bypasses one of the safeguards of the CMS acute care at-home program. However, hospital at home programs not directly funded by Medicare do not have this eligibility requirement. There is concern that private hospital at home programs will not have the same consumer protections in place, which could create issues down the road.
Whomever is at the forefront of advancing hospital at home programs, it’s clear that the race to dominate the market is still in its infancy. As more players, both traditional and new, venture into this space, a blend of competition and collaboration could shape the future of healthcare. We can only hope that this makes it more accessible, efficient, and patient-centric. The challenge will be to strike the right balance between cost-saving and ensuring high-quality care.
Advocates Perspective
Hospital at home programs have emerged as an innovative approach to healthcare, bridging the gap between clinical services and patient comfort. By delivering high-quality care in the patient’s own environment, these programs present a promising future for healthcare delivery, especially for specific patient groups. However, as implementation of these programs advances and more players come into the market, it is important to keep patient satisfaction, choice, and quality of care at the forefront. What will be interesting to see is that as the healthcare landscape continues to evolve, it will become clear that this model isn’t exclusive to hospitals. The collaborative approach integrates services from many healthcare providers. This demonstrates the viability of a shift from traditional inpatient care as well as an expansion of outpatient services. The home is increasingly being seen as an extension of care and it will be interesting to see how this healthcare at home model and industry continues to evolve.
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.