HOSPITAL AT HOME

Many regard the hospital-at-home model as a viable way to increase value, as US hospitals reevaluate how and where they provide treatment to patients. Some patients who require acute-level treatment can receive this at home rather than in a hospital. It has been demonstrated that this approach to care delivery lowers costs, improves results, and improves patient satisfaction.

Hospital-at-home

Depending on the requirements and capability of the hospital and its patient population, the form and execution of US hospital-at-home care vary. While some hospitals rely on referrals from local paramedics or specialist clinics, other hospitals operate the program out of the emergency department (ED) and admit qualified patients to their homes. Hospitals may concentrate their hospital-at-home care efforts on a particular patient demographic, such as oncology treatment or post-surgical surveillance, allowing a planned “home admission” to replace or reduce an inpatient stay. In order to satisfy the needs of patients in rural areas, hospitals are increasingly adapting home hospital care.

Hospital-at-home care models may differ in form, but programs often have similar elements. Medium-acuity patients who require hospital-level care but are deemed stable enough to be safely monitored from their homes are well-suited for hospital-at-home care. While not all patients are suitable for hospital-at-home care, those who have illnesses with well-established treatment plans, such as cellulitis, congestive heart failure, pneumonia, or chronic obstructive pulmonary disease (COPD), are especially well-suited.

Despite not physically being there, patients are never far from medical professionals. Through a combination of in-person visits, video visits, and ongoing biometric monitoring through telehealth technology, they are continuously connected to their care team.

Hospitals can provide several kinds of services in the home settings, among which: diagnostic tools, treatment and services such as respiratory therapy, pharmacy delivery and skilled nursing services.

Why is this interesting?

Inpatient care is extremely costly to hospitals both in the US and in Denmark. In some US locations, a brand-new hospital with 500 beds might cost more than USD 2 billion. The cost of healthcare in the United States is already the highest in the world. In many cases, hospitals are not even the best settings for healing. Patients get infections, which can occasionally be fatal. Sleep and healing are disturbed by the continuous alarms and noises of all the technology and monitoring. Finally, the pandemic’s terrible effects on hospitals have been the strongest motivator to a shift towards care-at-home services.

In today’s challenging operational environment, hospitals are reducing non-essential spending, but they are still eager to invest — only more carefully and in businesses that can quickly reduce costs or increase revenue. While the COVID-19 pandemic has offered a catalyst to reinvent hospitals’ future, the increasing disease load, aging population and rising healthcare expenses have already contributed to an increase in Care at Home services in both the US and Denmark.

As a result, new capacities and technologies are now appearing: more people can now receive care at home thanks to new technologies. From a Danish perspective, such trend is interesting to follow: first, Danish hospitals have an opportunity to learn from US practices, US pilots and investment decisions. Second, the care-at-home segment is only expected to grow in the future, resulting in an opportunity for Danish start-ups designing care-at-home technologies to shine and to attract US investments.

An increasing amount of US data demonstrates that hospital at-home care is a successful technique that improves all three aspects of the value equation: patient experience, outcomes, and cost. While the latter have always been part of Danish hospitals’ functioning and funding framework, patient experience is becoming increasingly important for Danish healthcare providers, leading them to also look into care-at-home solutions to ensure the continuum of care.

How Far Are we?

In the US, the costs of a shift towards care-at-home service has attracted the interest of policy makers. The Centers for Medicare & Medicaid Services – in charge of the reimbursement of clinical procedures and products in the US – introduced the Acute Hospital Care At Home program in November 2020 to give hospitals more freedom while caring for patients at home, even more in the context of the COVID-19 Pandemic. In April 2023, The White house issued an executive order on increasing access to High-Quality Care and Supporting caregivers, recognizing the need to better evaluate and set expectations for family caregivers in the Acute Hospital Care at Home program.

A wide diversity of digital health technologies are currently used or envisioned to support the shift from acute inpatient care to care-at-home which gives opportunities for start-ups. Keeping into account that a substantial amount of patients enrolled in care-at-home initiatives are over the age of 65 and have limited technology literacy, it is critical to hospitals like Mass General Brigham to develop technological platforms that brake down the barriers to patients using individual technologies (e.g. dedicated tablet, technologies for patients with visual or hearing impairments). A strong interest is observed for wearable sensors that provide continuous hospital-level monitoring of patients’ vital signs, such as a chest patch that records the heart’s activity or actigraphy and accelerometer sensors that monitor patient movements. It is expected that sensor technologies will allow physicians to measure even more advanced parameters in the future, in a fully touchless manner. Artificial intelligence is foreseen to address massive amounts of data generated from sensors. Hospitals hope that AI technologies will be able to predict with accuracy the course of a patient’s disease based on physiologic measurements.  

Investments to date have been significant in the US. Typical investors are healthcare providers such as hospitals and clinics. According to recent surveys, up to USD 265 billion worth of care services for US Medicare beneficiaries could shift to the home setting by 2025. Together, Kaiser Permanente and the Mayo Clinic invested USD 100 million in Medically Home. Mass General Brigham expects its home-hospital expansion to result in annualized savings of USD 1.3 million as part of its performance-improvement plan. Some hospitals, such as Mass General Brigham expect an upcoming digit growth of hospital-at-home services to replace inpatient services in the future. They also foresee such shift to rapidly growth by 2 to 3 times in the coming 6-9 months, and within the next 10 to 15 years, 15% to 30% of inpatient care may be provided from home.

Corporate: Several programs have been initiated by US hospitals and demonstrated results:

University of Utah Health’s Huntsman Cancer Institute offers the Huntsman at Home service (2018) to oncology patients, enabling them to leave the hospital sooner or avoid going in altogether. In a study of the impact of the model, Huntsman at Home patients were 58% less likely to be admitted for an unplanned hospital stay, and those who were admitted to the hospital had a shorter length of stay. Huntsman at Home patients had 48% fewer Emergency Departments (ED) visits.

Mount Sinai’s at Home program provides hospital services and rehabilitation services to acutely ill patients who would otherwise require hospitalization. Patients who receive hospital-at-home care have fewer complications, fewer 30-day ED visits, lower 30-day hospital readmission rates, and decreased length of stay. Mount Sinai also reported increased patient satisfaction and lower cost of care. To enable private insurance companies to pay for hospital-at-home, Sinai formed a joint venture with Contessa Health to facilitate the development of contracts with health plans and other payers.

In regards to academic research, it is currently performed in the US to demonstrate and enhance the value proposition that home care has to offer patients and the entire U.S. health care system. Several institutes and organizations are dedicated to deliver research outcomes in the segment:

The Research Institute for Home Care is a non-profit, national consortium of home care providers and organizations. The Institute invests in research and education about home health care and its ability to deliver quality, cost-effective, patient-centred care across the care continuum.

The Agency for Healthcare Research and Quality, part of the US Department of health and Human Services, regularly publishes evidence reports on home-based primary care interventions, complementing research in the acute space.

University of Pennsylvania’s Institute of health economics also investigates the shift delivery of acute hospital care into the home

The American Hospital Association publishes data on the design, outcomes and objectives of care-at-home studies performed by US hospitals.

Let’s connect

Please reach out to Ines Benabida ineben@um.dk at ICDK Boston for any inquiries. We offer our services to both corporates, SME’s and academic partners looking to dive further into the area of life sciences and green transition.

Sources

[1]: World medical Innovation Forum 2023. Boston. June 2023.

[2]: Shepperd S., Iliffe S., Doll H.A., et al. Admission avoidance hospital at home. Cochrane Database of Systematic Reviews 2016

[3]: Levine D.M., Ouchi K., Blanchfield B., et al. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020 Jan

[4]: Caplan G.A., Sulaiman N.S., Mangin D.A., et al. A meta-analysis of “hospital in the home”. Med J Aust. 2012 Nov.

[5]: Levine, et al.

[7]: Caplan, et al

[8]: Helen Ouyang. Your Next Hospital Bed Might Be at Home. New York Times. Jan 2023

[9]: Oleg Bestsenny et al. From facility to home: How healthcare could shift by 2025. Mckinsey February 2022

[10]: Oleg Bestsenny et al. From facility to home: How healthcare could shift by 2025. Mckinsey February 2022

[11]: Jiang Li. Examining-the-realities-of-hospital-at-home-technology-implementation. Forbes. April 2023

[12]: Bruce Gordon. Staying at home growing remote monitoring for post acute care patients. Medcitynews. 2022

[13]: ICDK Boston Data.

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