Hospital at Home: A Growing Trend in Home Care

Post Written by Sarah Dunbar, Business Solutions Associate

Sarah Dunbar recently attended the National Advanced Healthcare at Home Summit. Here are her key takeaways:

The hospital-at-home model of care is gaining popularity, and given its clinical and financial benefits, continued growth over the coming years should be expected. I recently attended the Virtual National Advanced Healthcare at Home Summit, a Heritage value-based care conference series. The variety of sessions and concepts, not only spoke to the increased interest in the model itself but also to the untapped potential of hospital-at-home programs across the country. As we consider the increased influence of these programs, it is essential that we assess the impact this growth has on the workforce, overall cost, and its influence on other home-based services.

What is Hospital-at-home?

Hospital-at-home programs are designed to provide short-term care to patients who need hospital-level care but are stable enough to be treated in the home. Eligibility criteria are focused on distinguishing patients who need intensive services and/or multiple visits from specialists and therefore require a hospital setting – from those whose needs can be met by a physician and/or group of clinicians at home.

What has catalyzed its growth?

Providing hospital-level care at home is not a new concept, but its popularity grew during the COVID-19 pandemic. In November 2020, the Centers for Medicare and Medicaid Services (CMS) issued a temporary waiver which allowed Medicare reimbursement for providing hospital-level acute care at home under certain conditions. More than 270 hospitals in 37 states have been approved for the CMS waiver. Even though these hospitals vary by region, population served, organizational structure and services provided, they share a home-based component driven by the CMS waiver. In December 2022, Congress approved the extension of the waiver program through December 2024.

What are key takeaways?

The conference covered a lot of ground. Sessions touched upon a variety of topics ranging from the foundations of hospital-at-home to understanding the liabilities that staff could encounter. While certainly not comprehensive, I wanted to share a few select key takeaways:

The “team” is vital to success: The success of these programs is contingent on a comprehensive care team that can deliver the necessary services to realize actual results. Case study after case study shared approaches to building these care teams, and a clear commonality among successful teams was the involvement of clinicians with field experience. Finding a field team that has experience providing care requires recruiting the best of the best. Given the current health care workforce struggles, it can be a significant challenge finding paramedics, field technicians and senior leadership who will drive success. Even if a company is able to recruit the needed members of a care team, caseloads and number of patients served in the at-home care model is considerably lower than those served in the hospital. Hospitals will need to be data-driven and strategic in creating clinical pathways that refer the most suitable patients who will benefit the most from the program - setting the stage to optimize both outcomes and potential savings. If quality staffing proves to be a persistent issue, it may be necessary to build partnerships across the healthcare ecosystem to provide comprehensive care.

Data is limited: Despite the impressive growth of the program, there is still some difficulty with contracting due to lack of data. There are only a few peer-reviewed studies that present reliable data on the cost-benefit tradeoffs for hospitals, including total volume of patients served across the nation. The CMS extension to 2024 did create opportunities for enhanced data collection as it included specific reporting requirements. The participation and performance data collected will hopefully inform the future of hospital-at-home and suggest long-term solutions to providing these services past 2024.

New trend, new competitors: The growth of the hospital-at-home program has already and will continue to attract competitors that offer turnkey solutions and offerings. These companies will seek to provide innovative solutions to complex problems such as staffing, medical testing, and enhanced care management that some hospitals might not be able to offer. The care model could also attract larger retailers such as Amazon and Best Buy. Best Buy owns the care-at-home platform ‘Current Health’ who earlier this year partnered with Atrium Health to support its hospital-at-home program. These larger competitors open the door for additional acquisitions that will scale service options and create a pathway for involvement in the hospital-at-home business.

The payment model is the key: As much as the CMS waiver provided a runway for hospital-at-home to grow across the nation, many of the conference participants discussed the payment barriers that exist due to a lack of payer acceptance. Despite the traction that the program has created, there are no guarantees that Medicare and private health insurers will continue to reimburse hospitals at the same rate if the waiver is not extended past 2024. There is still hope that insurers will begin to embrace and incorporate more value-based components to the program’s payment model. Some health systems pay for the hospital-at-home program through their integrated health plan or a third-party partner to help mitigate risk. Some, like CommonSpirit, have partnered with Contessa and adopted bundled payments. However, until an established payment and reimbursement structure is in place, a lot of unanswered questions remain.

Did we forget about skilled and unskilled homecare? Perhaps my most striking realization from the conference was that the impact of hospital-at-home on skilled and unskilled home care services was not discussed. Home health and home care, also known as skilled and unskilled home care, were in place in homes across the country long before hospital-at-home became popular. Although there are many differences between home care and home health care, both have been helping older adults stay safe and independent in their homes. How will hospitals collaborate with home health or home care agencies to leverage their reach? Will patients who are already established with at-home caregivers experience engagement fatigue due to the increase of individuals in the home? Hospitals will need to leverage homecare agencies and services to ensure that best outcomes for patients continues to be the center of the care-model. Agencies that are able to find innovative ways to partner with hospitals will pave the way for more discussions around leveraging existing homecare programs.

There is much to look forward to in the next year, including a glimpse into the data as CMS is scheduled to report to Congress regarding the hospital-at-home program in 2024. While there are a lot of unknowns, the potential for a larger shift to comprehensive and high-quality at-home programs and services is exciting.

Are you interested in innovative models of care and would like to discuss home care or at-home programs? HSG has experience in both of these spaces. Reach out and learn more about how we can work together to implement innovative programs and drive better outcomes.

About the Author: Sarah Dunbar is a Business Solutions Associate at Helgerson Solutions Group. Connect with her on LinkedIn.