As hospital-at-home gains momentum, healthcare systems are increasingly turning to outside companies for help operating the programs.
The hospital-at-home model, in which a patient receives acute-care treatment scheduled at home, has been around for decades, but the COVID-19 pandemic set off a swift wave of investment and growing utilization as inpatient beds became scarce. Healthcare research firm Chilmark released a report earlier this month projecting hospital-at-home to grow into a $300 billion industry by 2028, with much of that growth propelled by third-party companies offering turnkey services.
“It’s a complicated process to stand up and turn on,” said Dr. Robert Moskowitz, corporate medical director for at-home care company Contessa Health. “For those that haven’t tried it yet, I think they look at all of the cogs on the wheel that need to fit into place, and it can become absolutely overwhelming.”
There are 283 hospitals across 37 states that have been approved for hospital-at-home programs, according to the Centers for Medicare and Medicaid Services.
Providers say care at home can keep readmissions in check, ease capacity constraints and save money for patients and hospitals. A study published earlier this year in the Annals of Family Medicine found readmissions and return emergency department visits for hospital-at-home patients did not differ significantly from those receiving traditional hospital care. Hospital-at-home was associated with shorter inpatient lengths of stay, the study found.
By enlisting outside companies for help, providers see opportunities to reach more patients in an efficient manner and tap into new resources, while also sidestepping some of the startup costs to develop their own programs.
Charlotte, North Carolina-based Atrium Health, part of the larger Advocate Health, launched a hospital-at-home program in less than two weeks in early 2020 as COVID-19 was spreading. As a now-$27 billion system, most of Atrium’s services are operated in-house, but it recently turned to Best Buy’s Current Health for additional support as it expands the program.
With that partnership, Atrium will have access to Best Buy’s Geek Squad employees to deliver and help set up remote monitoring equipment in patients’ homes.
“People who had started hospital-at-home and chronic disease management programs [in-house], they are all calling us now,” said Deborah DiSanzo, president of Best Buy Health, which acquired its Current Health platform in 2021. “I think everybody started it [in-house] because they had to. … Who was running those programs? It was physicians and nurses. [But] you know physicians and nurses are already overburdened with work.”
Colleen Hole, administrator of hospital-at-home at Atrium, said the goal is to reach 50 patients per day by year’s end, compared with the current 20-plus patients. Since launching, Atrium’s program has served more than 7,000 patients with more than 150 conditions, including congestive heart failure, pneumonia and chronic obstructive pulmonary disease.
Atrium also is looking to form a partnership for X-ray and ultrasound imaging support in the home, she said.
“We often hear, ‘We don’t have enough acute-care beds [in hospitals],’ … and with the aging population, it’s going to exponentially increase our need for acute care,” Hole said. “I would argue we do have enough beds. They’re just in people’s homes.”
Worcester, Massachusetts-based UMass Memorial Health has partnered with Current Health for remote monitoring, VNA Care for physical and occupational therapy and Trident for in-home ultrasounds and X-rays.
Dr. Taki Michaelidis, medical director for the system’s hospital-at-home program, said one of the system’s biggest challenges is ensuring personal care aides are quickly made available for patients. Home health agencies are used to fulfilling requests in a couple of days for less acute patients, he said.
UMass Memorial, which launched its program in 2021, is working with local agencies to keep response times within an hour range. The nonprofit system would like to find additional partners to help with logistics across its central Massachusetts footprint.
“If you leave our medical center, you can be in an urban city in five minutes, you can be in suburban areas in 10 minutes, and you can be in farmland in 15 minutes, so it’s a very, very diverse area in our part of the state,” Michaelidis said.
Dr. Ania Wajnberg, a geriatrics and palliative medicine professor at the Icahn School of Medicine at Mount Sinai in New York, said operating hospital-at-home means battling decades of centralization in acute care, and Mount Sinai looks for vendors that aren’t afraid to deviate from the standard. The system launched hospital-at-home in 2017 through a joint venture with Contessa, and in 2020 also began working with Current Health.
Mount Sinai is open to additional partnerships and vets potential vendors based on timeliness, reliability and communication, in addition to scalability, she said.
“We’ve really tried to find who the most innovative vendors are, which vendors are really willing to work on something that’s changing healthcare,” Wajnberg said.
