The hospital-at-home model can treat routine infections to chronic diseases, including emergency care, cancer, acute COVID-19 cases, infusions, lab and imaging tests, rehabilitation, behavioral health and transfusions. Nurses, physician assistants and community paramedics will deliver in-person care with the help of a 24/7 command center staffed by clinicians and an integrated care team.
In Mayo and Kaiser’s pilot programs, Medically Home patients’ readmission rates dropped and satisfaction significantly improved compared to traditional hospitalizations, said Dr. John Halamka, president of Mayo Clinic Platform, the system’s data analysis division.
“We have been able to achieve the same quality, the same safety and the same outcomes, but very significantly higher patient and family satisfaction,” he said during a call with reporters Wednesday. “When we enter a patient’s home, we are forced to assess the whole patient, the whole family and the social determinants of health.”
Halamka referenced an elderly patient who had low sodium, which would typically require hospitalization. Medically Home headed off an expensive and taxing hospital stay by helping him and his spouse source nutritious food, he said.
More care that has been confined to the hospital, including infusions, is branching out to patients’ homes. Providers and insurers aim to reduce costs, bridge social inequities and care gaps that impede access and improve outcomes.
The COVID-19 pandemic further propelled that push as hospitals needed to free up inpatient beds, leveraging remote monitoring technology for acute but stable patients. Telehealth waivers, which have broadened the scope of telehealth services that Medicare covers, relaxed site-of-service regulations and boosted reimbursement, have also fueled the transition.
The regulatory and financial support via CMS’ Hospitals Without Walls program along with the COVID-19 pandemic’s emphasis on technology-enabled care and health equity have bolstered the hospital-at-home model, said Raphael Rakowski, executive chairman of Medically Home, which currently has 167 employees.
“The Hospital Without Walls program from CMS has created the confidence not just around the reimbursement opportunity, but if CMS endorses it and has done its diligence, there is a layer of safety that is assumed,” he said. “COVID has taught us that we probably need a combination of adding more flexible capacity and recognizing what is most the appropriate use of brick-and-mortar facilities.”
Patients and their families will receive a custom-designed iPad and two-way radio that provide access to around-the-clock consultations. Their homes will be equipped with backup power and cell signals, remote monitoring tools, emergency response systems and durable medical equipment.
They need to be within 30 miles of a participating hospital and have a home that’s suitable for their treatment and recovery. Intensive care patients and some undergoing complex surgeries aren’t suitable for home care, but there is a vast majority of patients who can be safely treated in their homes, said Margaret Paulson, chief clinical officer for advanced care at home for Mayo’s Northwest Wisconsin region.
Medically Home estimates that 30% of hospitalized patients can benefit from its services.
“We are essentially right-sizing for the future,” said Dr. Stephen Parodi, executive vice president at the Permanente Federation.
Mayo Clinic launched its advanced care at home program last summer at Mayo Clinic in Florida and Mayo Clinic Health System in Eau Claire, Wisc. Kaiser Permanente kicked off its hospital-at-home program in two regions last year, admitting patients from multiple hospitals across both its Northern California and Oregon locations.
Not-for-profit health systems, including Adventist Health, ProMedica and UNC Health, use Medically Home. It has also partnered with Huron and Cardinal Health.
“This model needs to be pressure tested amongst (our) different populations and locales,” said Parodi, adding that the logistics of in-home care need to mirror the hospital setting. “I also see a tremendous opportunity for our teams to exchange experiences.”
Rakowski said he has talked with 113 health systems since last year’s initial announcement in the U.S. and abroad. About 140 hospitals have applied for CMS’ hospital-at-home waiver, which is another signal of growth, he said.
Rochester, Minn.-based Mayo reported an operating income of $728 million on $13.9 billion in revenue in 2020. That was down from $952 million in operating income on $13.7 billion in revenue in 2019, according to Modern Healthcare’s financial database.
Oakland, Calif.-based Kaiser, which comprises Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, generated $2.2 billion in operating income on $88.7 billion in revenue in 2020, or a 2.5% margin. That’s down from $2.7 billion in operating income on $84.5 billion in revenue in 2019, a 3.2% margin.