Blog | 11/8/2024

Home is Where the Health Is: Why Hospital-at-Home Should be Here to Stay

By Greg Chittim, Partner and Managing Director, Jeffrey Abraham, Partner, and Shreya Saraf, Director

Hospital-at-home (HaH) is one of those rare health innovations that (should) truly align incentives of all key stakeholders: patients, providers, payers, and digital health players. Despite this promise, adoption of HaH programs has been limited, plagued by challenges including operational complexities, workforce limitations, and regulatory uncertainties. Nonetheless, we are optimistic on this trend and expect CMS regulations along with technological progress to drive widespread implementation in coming years.

Health Advances is working closely with the Connected Health Collaborative Community (CHcc), co-hosted by the Digital Medicine Society (DiMe) and Consumer Technology Association (CTA) on its inaugural project, Advancing a Sustainable Hospital-at-Home Ecosystem at Scale.

The hospital-at-home concept involves delivering acute care services traditionally provided in a hospital setting directly to patients' residences. This model has gained traction due to several factors, including the COVID-19 pandemic, which accelerated the adoption of telehealth and remote monitoring technologies. By utilizing digital tools, healthcare providers can monitor patients' vital signs, manage medications, and deliver treatments without the need for physical hospital visits. By integrating remote monitoring, telehealth services, and patient-centered approaches, this model not only enhances access to care but also empowers patients to take charge of their health in a supportive environment. 

CMS’ recent report on its Acute Hospital Care at Home (AHCAH) program supports the clear benefits of HaH despite current limitations: The study revealed that patients receiving at-home care through the initiative incurred lower Medicare spending during the 30-day post-discharge period. Despite receiving the same services as those in traditional hospitals, at-home patients utilized fewer resources, indicating that hospitals can reduce costs over time by providing care in home settings. Feedback on at-home care was overwhelmingly positive, with patients feeling more relaxed and less anxious, aiding their recovery. Caregivers noted that the familiar environment significantly contributed to better health outcomes.

While there is widespread support and energy around HaH, there are certainly skeptics. Notably a recent piece in Health Leaders, No Going Home. Hospital at Home is a Hype Machine urges a move away from “toxic positivity” with more focus on the grappling with questions of cost, complexity, and culture as well as scaling the solutions to each.

Widespread adoption of HaH models necessitates a non-trivial change in behavior for providers who, despite best intentions, are limited today by their time, resources, training, and technological tools to do so. In addition to ongoing training of personnel, health systems may need to revisit organizational structures with clearly defined roles and responsibilities. This can also go a long way in addressing operational challenges for the provider as well as alleviating the caregiver burden of HaH, particularly for patients with limited mobility.

Another essential element is equipping providers with the right tools and analytics to effectively coordinate all of these efforts. Digital health players have made significant strides in this space over the last year, making us more optimistic about overcoming these hurdles. The CHcc referenced above includes companies like:

  • b.well to unify fragmented healthcare data and services;
  • CareSet to focus on Medicare data for complex patient journeys;
  • Medically Home for delivery of complex care at home;
  • Vivalink as a platform for remote patient monitoring; and
  • Ypsomed to support self- and family-driven care.

The future of HaH heavily relies on regulatory frameworks and reimbursement models –CMS introduced waivers to facilitate reimbursement for home-based care during the pandemic, which are set to expire on 31st December 2024. A bill to expand the initial scope of the Acute Hospital Care at Home (AHCAH) program - At Home Observation and Medical Evaluation (HOME) Services Act – was introduced earlier this year. Continued advocacy for policy support and investment in technology will be crucial in ensuring that HaH programs can thrive and become a permanent fixture in healthcare delivery.

Authors

  • Greg Chittim, Partner and Managing Director, Co-leads Health Advances’ Health IT and Digital Health practice
  • Jeffrey Abraham, Partner, Co-leads Health Advances’ Health IT and Digital Health practice
  • Shreya Saraf, Director, member of Health Advances’ Health IT and Digital Health practice

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