Does Hospital-at-Home Really Represent the Future of Healthcare?

Telehealth and caring for patients at home has increasingly been in the spotlight over the past 24 months. McKinsey predicts that $265 billion worth of care services for Medicare FFS and MA beneficiaries could shift from traditional healthcare facilities to the home by 2025.

Similarly, Gartner projects that more than three-quarters of healthcare providers will shift 20% of hospital beds to the home by 2025.

Powerful numbers. But are they real? Is the massive network of brick-and-mortar healthcare facilities about to be dramatically altered by digital health initiatives, like retail malls rendered obsolete by online shopping?

Time will tell, but last week’s ATA annual conference in Boston revealed strong momentum toward the care-at-home market. During the conference, attendees learned about Massachusetts-based UMass Memorial Health’s Hospital at Home program, which has treated more than 320 patients since being unveiled less than a year ago. The program treats 12-15 patients daily, with an average at home stay of nine days. Perhaps most impressive is the group’s 2.3% readmission rate.

“This is a model that people need to think about and embrace for the success of future healthcare,” said Deidre Rolli, Clinical Care Coordinator for the UMass program.

Deidre Rolli, Clinical Care Coordinator for the UMass program, stressed that the initiative includes patients that are such high risk that they haven’t seen their primary care in a year because they’ve been in and out of the hospital. “There are weeks when our acuity is higher than a med surge floor within a regular hospital,” she said during the ATA presentation. “This is proof that you can take care of very sick patients in their home with the right dynamic and the right team.”

While the success of the UMass program is remarkable, and an indicator of what is possible in the future, we are still clearly at the very beginning of the home health frontier. Some very legitimate players have emerging on both the provider and the healthcare solutions side. Many vendors on the ATA exhibit floor offered impressive credentials, both in the solutions offered and the number of providers using their products.

However, major challenges must be addressed for hospital-at-home to become widespread. For starters, this movement requires a different breed of nurse. Rolli acknowledged this during the educational session she delivered with Current Health, now a part of ATA exhibitor Best Buy. Most nurses are not accustomed to providing home health care. In a traditional nursing setting, the nurse is in charge. However, that script is flipped when a nurse delivers home care, where the patient is in charge. The UMass nursing staff goes through a 30-day training program that covers this issue, including technology and security.

Despite the nursing challenge, there are many benefits. For starters, the care-at-home strategy can help to alleviate clinician burnout by enabling them to work when and where they want to. This point was emphasized several times during ATA’s educational sessions. With clinicians leaving their jobs due to stress, the home health market represents new opportunities to counter the mounting clinician shortage.

In addition, Rolli said her staff find delivering care in the home to be extremely gratifying. Providing care at the home gives clinicians full visibility to what is going on with the patient – identifying issues like food insecurities, outreach programs they need, and if their home has heat, for example. These are all issues that a PCP has little insight into.

“Our nurses have never experienced such professional gratitude because people appreciate what they are doing so much,” said Rolli.

Preparing nurses for at home visits is likely less challenging than the other changes that must occur to accelerate home care, primarily in payment models. Home treatment is all about value-based care, not the fee-for-service payment structure we are still mired in today. This structure does not come close to aligning with telehealth and home care strategies.

Integration is also an issue. Considering the lack of overall interoperability in today’s marketplace, imagine the possible complications from a home care environment.

Much attention must also be paid to how specific of a population can be treated at a hospital-at-home setting. This is clearly not an everyman’s game. However, some providers and vendors are trying to be the everyman. Tremendous thought and planning must go into determining the proper patient characteristics to be treated successfully at home.

When done right, the hospital-at-home can likely minimize the “race to discharge,” a chronic healthcare problem which often leads to readmission. Care-at-home represents an opportunity to convert to a “race to properly discharge.” However, it will require massive shifts in capabilities and decades-old practices and processes. It will be interesting to see if the hospital-at-home concept finally provides the incentive needed to break the code.

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