By Claire McGee, Associate

COVID-19 has undoubtedly changed how we think about healthcare in countless ways. Perhaps most notably, providers, payers, and consumers are rethinking where, when, and how we deliver and receive care. In the US, telehealth is now utilized 38x more than it was in February 2020 (after peaking at 78x) and makes up about 13-17% of all office and outpatient visits.[1] Various payers and managed care organizations have expanded their reimbursable telehealth codes and venture investment in all versions of virtual care has exploded. However, these areas of growth may represent just a small portion of care that could someday be delivered in the comfort of your own home. Hospital at Home Care (HaH) is a model that provides acute, hospital-level care at home. In response to the pandemic, we are seeing wider and wider adoption of this model and some exciting HaH solutions enter the market.

A Brief History

First developed by Johns Hopkins Medicine in 1995 and tested in a National Demonstration and Evaluation Study in 2000-2002,[2] HaH was gradually making its way into the mainstream until it expanded rapidly following the onset of the pandemic. In an effort to quicken the implementation of HaH programs, increase capacity in hospitals, and maximize resources for critically ill COVID-19 patients, the Center for Medicaid Services launched the Acute Hospital Care at Home program in March 2020. The program accredits HaH programs all across the US, ensuring that all meet a certain set of requirements and reporting measures.  Since the implementation of this program, 83 health systems and 187 hospitals in 34 states have become CMS approved facilities for acute hospital care at home.[3] This includes notable systems such as Mount Sinai health system, Brigham and Women’s Hospital, Massachusetts General Hospital, Mayo Clinic, and Cleveland Clinic, among many others.

Patient Journey:[4]

Note: This is just one example of HaH care. Models may differ significantly depending on diagnosis and care facility.

  1. Upon intake the patient either arrives through the ER or is routed directly to a Hospital at Home provider. Following triage, their eligibility for HaH is determined by ER staff, most commonly an ER physician. While many factors go into this decision, the physician most often considers the patient’s diagnosis related group classification, acuity of condition, and the location of the patient’s home relative to the care team. Some common conditions that could qualify a patient for at-home care include pneumonia, dehydration, acute cellulitis, deep venous thrombosis, and exacerbations of conditions like heart failure or chronic obstructive pulmonary disease (COPD).

  2. Once deemed eligible, the patient begins treatment at home. This includes daily visits by a member(s) of the care team, whether that be a nurse, nurse practitioner, or physician. Other members of the care team can include social workers, physical therapists, home health aides, lab techs, and X-ray/EKG techs depending on the specific model of home care. During this period, 24-hour-on call telephonic services are available to the patient and/or their caregiver.

  3. Following the acute care episode, the patient enters a monitoring phase. At this point, the patient is “discharged” from the HaH program, but both 24-hour-on-call telephonic service and home visit support is available if needed and clinically appropriate.

Outcomes 

One example of a health system who has seen positive outcomes is Mt. Sinai Health, who was an early adopter of the HaH initiative. Hoping to mitigate overcrowded NYC hospitals, Sinai launched its program in 2014 after receiving a 3-year, $9.6M grant from the CMS Innovation Center. In their trial, they found that patients included in the HaH program had an 8.6% 30-day readmission rate, compared to 16.1% of similar patients. Moreover, patients also had fewer ED visits and reported an overall better experience.[5] The health system went on to propose a HaH payment model to Medicare in 2017 (currently awaiting approval) and continues to operate their program through the pandemic, negotiating directly with payers.[6]

As shown in this instance and beyond, there are potentially large financial incentives for health care systems and businesses in the US to implement HaH programs. HaH has been seen to reduce total cost of care by up to 30% by reducing the length of stay and readmission.[7] Moreover, the patient often reports a better quality of life, citing less time sedentary and increased dignity when compared to a traditional hospital stay. Ultimately, the HaH method provides a smooth continuum of care for the patient, enabling an easier transition back to independence.

HaH Technology and Services Market Landscape

These cost-saving outcomes make HaH an attractive option for hospitals and payers. Many single payer countries have had wide success with HaH, however, adoption has been slower in the US. In response to the complexity of regulations and gaps in coverage in the US, we are seeing several startup efforts to lower costs for health systems and provide quality HaH programs. As a result of new regulatory changes and recent technology innovation and enablement, the market is primarily emerging/growing. However, the large market ceiling (home healthcare market currently projected to reach $541.1B by 2028),[8] potential impact, and permanent shifts in the health care landscape following COVID-19 make for a hyper-competitive market with high rewards.

Because of the extensive list of CMS requirements and reporting measures needed for reimbursement, there are still relatively few market players and leaders. Those currently leading the pack include Medically Home, Contessa Health, and DispatchHealth . This limited market creates a scenario in which each company is vying to readily claim territories, and care models have yet to meaningfully diverge.

  • Medically Home: Founded in 2016, Medically Home is a tech-enabled clinical enterprise solution which enables health systems to deliver care to high and medium acuity patients in the home.

  • Contessa Health: Founded in 2015, Contessa Health operates risk-based recovery models and provides administrative support services for acute care, post-acute care, and surgical procedures. Contessa was acquired by Amedysis, $250M post-money, in June 2021.

  • DispatchHealth: Founded in 2013, DispatchHealth delivers mobile and virtual healthcare for urgent and high acuity patients in the home.

See below for a high-level breakdown of the market and comparison across the key players:

Final Thoughts

The HaH market remains nascent with limited penetration following the pandemic. However, as we all know, many aspects of virtual health care are here to stay — and solutions that are providing de-centralized care with less expensive, trained resources on the ground (all of which is enabled via some degree of technology) are being met with a lot of enthusiasm. As of now, there is still limited penetration, aside from a few market leaders from both a vendor and health system perspective. It’s an exciting, growing market and we are excited to see new, innovative players enter and succeed.

[1] https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
[2] https://www.johnshopkinssolutions.com/solution/hospital-at-home/
[3]  https://qualitynet.cms.gov/acute-hospital-care-at-home/resources
[4] https://www.johnshopkinssolutions.com/solution/hospital-at-home/
[5] https://www.aha.org/system/files/media/file/2021/01/value-initiative-case-study-hospital-at-home-mount-sinai-health-system-new-york-ny.pdfhttps://www.aha.org/system/files/media/file/2021/01/value-initiative-case-study-hospital-at-home-mount-sinai-health-system-new-york-ny.pdf
[6] https://hbr.org/2019/05/inside-mount-sinais-hospital-at-home-program
[7] https://www.johnshopkinssolutions.com/solution/hospital-at-home/
[8] https://www.prnewswire.com/news-releases/home-healthcare-market-size-worth-545-1-billion-by-2028-grand-view-research-inc-301386287.html

Hospital at Home: The Future of Health Care

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