The future of health care is in the home. For a few decades, institutions around the world have been experimenting with a new model of care that would make that mission more of a reality. Now, COVID-19 has served as the urgent circumstance – hospitals at capacity for beds – to make this a much richer pursuit that has governments on board.
This emerging model is called hospital-at-home and it is about to underpin a much-needed shift in the way patients with a whole host of conditions are treated. In a new roundtable discussion, AlayaCare welcomed a panel of experts to explore this subject and what it means for home care providers.
We thank Dr. Bruce Leff, professor John Hopkins School of Medicine (a pioneering voice of hospital-at-home in the U.S.), Joel Thiesen, CEO of Lifesprk (a Minnesota agency that covers senior care in any setting), and Robert Holly from Home Health Care News for joining us in this timely discussion.
If you missed the discussion, you can watch the full recording and read about the key highlights below:
Hospital-at-home rose long before COVID to early success.
The hospital-at-home idea first gained traction in the U.S. in the 1990s when it became increasingly apparent that older adults would avoid hospital visits because of poor experiences they’d had in the past. Due to the prevailing opinion that hospitals weren’t the ideal location for aging adults to receive ongoing care, some health systems (beginning with Johns Hopkins) started to test whether hospital-level care could be delivered inside people’s homes, and whether it could improve patient outcomes.
Early pilots in Baltimore revealed that hospital-at-home led to good care experiences, better outcomes, and lower costs. After the turn of the century, national studies within the scope of Medicare further validated the idea. Before the pandemic, dozens of trials around the world had already shown it to be a solid model – even reducing a person’s risk of death six months after treatment if managed at home rather than in the hospital.
Some countries like Australia, Canada and Spain have started to embrace this model over the past decade. In the U.S., adoption has been slow in large part due to the payment landscape. In the wake of the pandemic, hospital-at-home has finally started to take off now that the U.S. government has created a waiver program for hospitals to start caring for patients at home.
The CMS made it easy for hospitals to apply
To expand quickly, Centers for Medicare & Medicaid Services (CMS) introduced the waiver and its associated payments to be un-complex and familiar. To secure a waiver and ensure quality, hospitals must provide the same services in home as they would in the hospital: physician care, nursing care, respiratory treatments, IV fluids, medications and skilled therapies. They need a plan in place, they must monitor safety, and they have to attend to the supply chain and logistics. (You’ll see some commercial players in that area now).
For any patient transferred from the ER or an inpatient wing to the home unit, approved hospitals can swiftly charge the CMS a DRG ("diagnosis-related group" payment) for an at-home admission. Outside Medicare, in a fee-for-service world, reimbursement was built through Medicare Advantage.
Home health agencies are critical partners to enable this hospital-at-home shift.
Agencies should view this shift not as “home health care plus” but simply as the next model, and what they are already doing can serve this model – so long as they have the necessary clinical skills in place.
Hospitals are seeking out good skilled home health care partners that are forward-looking and capable of designing and implementing a revised system. Agencies must understand that it does require a significant operational jump because coordination, timing, logistics and supply chain happen at much faster clip.
Hospital-at-home requires an agency to partner with a hospital to enable the patient transition from hospital to the home environment. Also, there needs to be a coordinated avenue for any patient who may need to return to the hospital should there be an “escalation of care.”
Case study: Minnesota agency implements hospital-at-home
Lifesprk is an agency that provides broad service including home health, community, hospice, palliative and primary care. As COVID ravaged New York in early spring 2020, they proactively strategized how they could help Minnesota hospitals get ready.
They approached North Memorial Health with the hospital-at-home idea, leveraging their technology and capabilities. Within a day, they had a functioning model set up to take clients from the ER and set them up at home. In lieu of a payer source, they devised a new system. They got paid per visit for Medicare original (primary care), and then used nursing visits to get paid under home care episodes. They could not access the hospital’s DRG funds so instead took the Medicare Advantage approach – and believe that as the home becomes the environment of choice, this effort will only grow.
During this pilot project, Lifesprk was ultimately able to serve 30 clients, none of whom had deterioration in health status. The success rang through in a 100% net promoter score for satisfaction. Each client in the end wanted to remove themselves from the hospital system and have their ongoing care managed through Lifesprk.
What do agencies need from a technology standpoint?
To be a successful player in hospital-at-home, agencies will need tools to be accessible on a mobile device. They will need an effective remote patient monitoring solution to capture client vitals and biometrics. And they will need a virtual visit solution to enable clinicians and nurses to check in as needed.
Another key aspect is that an agency’s system must be fully interoperable with the primary source of a client’s EHR. This must have a seamless, real-time connection.
At AlayaCare we will keep tabs on this evolution and work to ensure home health organizations are best equipped from a technology standpoint to embrace the opportunities with hospital-at-home. Visit our hospital-at-home page for more information and to reach out to us to see how we can set you up for success.