Posted on October 15th, 2021 in Perspectives

Our healthcare market has changed drastically in the past year which has enabled many care-at-home services to be viable care pathways. CMS announced a new reimbursement model for acute Hospital at Home services in November of 2020. This influenced payers, who have quickly recognized the benefits of Hospital at Home care. Many are willing to participate in new reimbursement models to support this care model as well. 

Hospital at Home will also impact an organization’s value-based care performance. While some health systems may have started their Hospital at Home programs to address bed capacity strains during COVID spikes, Hospital at Home services are intended to treat a broad variety of conditions.  When we think about today’s consumer-based healthcare market, patients prefer to be in their homes. All of these factors have converged to create an opportunity for health systems and payers to establish long-term sustainable Hospital at Home programs.

Globally, caring for patients in the home is a standard of care that’s been in existence for years.  In fact, many of the EHR’s that we’re familiar with support Hospital at Home workflows in international markets.  It’s only in the U.S. where Hospital at Home is not mainstream – but we’re on the brink of this becoming a standard of care and it’s exciting.  As of September 2021, 71 health systems across 33 states are currently approved for Hospital at Home reimbursement with many more to follow.

Numerous Hospital at Home research studies show that a reduction in the total cost of care averages 35 – 40% compared to inpatient bed care.  Hospital at Home is a maturity step forward for an organization transitioning to value-based care. A health system will improve its performance with a reduction of length of stays, lower readmission rates and avoidable ED visits, and lower SNF admissions.  With the variety of payment models that exist now, it is absolutely possible to establish a financially sustainable Hospital at Home program. To all health system leaders, take note that the Payers understand this and are entering the market themselves. This means new market competition between payers & health systems is increasing the pressure on health systems. In our consumer-driven healthcare market, patients seeking Hospital at Home care who find that their neighborhood healthcare system does not provide it, will look to their payer plan for it. 

Organizations developing a Hospital at Home program will
want to include the above elements in their framework.

This type of new care delivery requires a new mindset which includes front line teams providing care across traditional business units. Create an executive level vision for how care will be delivered in the organization. Establish a culture of rapid and scalable innovation for safe, high-quality care across all care teams,  including home care.

Care management teams are often siloed while existing in many different areas of an organization. Begin by understanding what types of care management and care coordination teams are in place in order to repurpose these resources with a cross continuum approach to care. Create a data driven approach by identifying the use cases and populations that would benefit the most from this type of care delivery.  A repeatable cycle that identifies staff resources, protocols and technology the organization will leverage to deliver this care model must be established to support continuous improvement.  Clearly identify and document new workflows for pharmacy, supply chain, scheduling and medication management and medical control. Leverage these defined care models and workflows to drive payer partnerships by create an environment of aligned incentives. 

Final Thoughts

Health systems must continue evolving their care delivery models to remain relevant. Health organizations, willing to address their Hospital at Home care readiness now, position the system to strategically establish an effective program achieving high patient satisfaction and value while meeting market demands.