Why go to a hospital when you can just have the hospital come to your home? This concept, of mobile ambulatory services coming to acutely afflicted patients’ homes, has been shown to decrease mortality rates, improve clinical outcomes, and decrease costs. Despite these clinical results, however, in the US hospitals-at-home have remained largely relegated to chronically ill cases, where an in-home nurse manages long-term treatment. Until very recently, in-home programs for patients with acute illnesses (think: Pneumonia and dehydration) who would otherwise need to be hospitalized were virtually non-existent in the U.S.
The hospital-at-home (HaH) model is much more prevalent abroad, in countries including Italy, Israel, and Australia. In the U.S., though, the healthcare payment model is complicated enough that devising a new payment system for a new healthcare system, without a single payer model, is extremely challenging. Because of this, despite the fact that hospital-at-home programs are one of the most studied healthcare innovations, they have only just started to be implemented in the U.S.
NewtonX recently conducted 10 calls with leading researchers with American HaH programs and pilot programs. The data and insights in this article are sourced from these consultations.
Lower Costs, Better Care: How Hospitals-at-Home Work
HaH models typically follow these steps:
- An emergency department physician determines a patient’s eligibility for inpatient admission and clinical appropriateness criteria for HaH (including whether the patient has safe housing).
- The patient opts for HaH
- The physician mobilizes HaH services (including nursing staff, oxygen, etc.)
- The patient is transported home with any necessary services by ambulance
- The nurse situates the patient at home, checks vitals and other signs, and communicates with the physician on the patient’s status, so the two can develop a care plan
- For a determined period the patient receives a combination of nurse visits, physician visits, video conferences via tablet, and any therapies, X-rays, blood tests, etc. necessary.
- At the conclusion of treatment, the patient is “discharged”, often with transition services available.
The average HaH “stay” is 3 days, compared to the national hospital stay average of 4.5 days. Studies have shown the HaH patients have between 19% and 38% lower six-month mortality rate compared to hospitalized patients. HaH stays resulted in fewer complications and greater satisfaction with care. The cost per day of a HaH is similar or cheaper to the cost per day of a hospital stay — and considering the decreased complications and shorter average stays, the cost reductions for HaH can be significant.
The US Institutions Paving the Way For Mobile Hospital Care (and the Challenges They Face)
HaH systems in the U.S. have faced their fair share of challenges aligning hospitals, providers and payers. However, it has been done successfully by multiple hospitals including Presbyterian Health Services in New Mexico, which has implemented HaH for its Medicare Advantage patients; the Veterans Association, which provides HaH at 11 sites; Mount Sinai, in NYC, which offers Mount Sinai at Home and has treated over 750 patients; and Cedars Sinai Medical Center in Los Angeles, which offers HaH in its accountable care organization and in managed care. Additionally, Geisinger Health System, will soon launch HaH.
The most successful of these is the VA, in large part because the network essentially acts as a single-payer system for its population. Other systems that connect hospitals with insurance plans likewise have an easier time rolling out HaH systems. Hospitals that do not combine with insurance plans need to enable contracts with private insurance companies for plans and payers.
Many of the researchers interviewed as part of this article believed that HaH systems will become increasingly prevalent in the US simply because of costs. Hospitals without connected insurance plans face barriers, but as Mount Sinai has shown, they are not insurmountable.