Evolving hospital-at-home models benefit patients and providers

Originally published in MedCityNews

In 2005, a study in the Annals of Internal Medicine demonstrated that digital home hospital, or hospital-at-home, solutions delivered better clinical outcomes, shorter average length of stay, higher patient and family satisfaction, fewer complications and significant cost savings, compared to traditional inpatient care. Since then, other research has shown similar findings including 70% reduced readmission rate, 40% lower cost and improved patient mobility for patients managed at home.

Despite these measurable benefits, adoption of hospital-at-home models is limited. However, several factors have recently converged to hospital at home implementation.

Pioneered by Johns Hopkins in 1995, the innovative hospital-at-home model provides hospital-level care in a patient’s home as an appropriate and, in some cases, better substitute for acute hospital care.

Current digital home hospital care models typically require eligible patients to be identified in the emergency department or an ambulatory care site. Once patients are admitted or accepted into the program, clinicians visit daily and all necessary care infrastructure—from infusion services to medication delivery devices to remote monitoring—is set up in the home.

Why now?

The Deloitte Center for Health Solutions identified several key reasons why hospitals are seeking to transform their business models, including the desire to reduce costs, maximize technology, better engage consumers, boost clinician satisfaction and compete with healthcare disruptors from Walmart to Amazon.

The digital home hospital concept offers potential for addressing all these challenges, especially given healthcare systems, physicians and patients alike embraced virtual care and digital technologies with newfound enthusiasm during the pandemic. Managing patient care virtually allowed patients fearful of Covid-19 exposure to be treated at home when possible. Simultaneously, hospitals stretched beyond capacity by waves of Covid-19 patients—and juggling limited resources—were able to hold more hospital beds available for more acutely ill patients.

In addition to the pandemic’s broadening acceptance for telehealth, it removed a major hurdle to digital home hospital adoption by spurring CMS and other payers to begin covering care provided outside of hospitals, including in patients’ homes.

McKinsey & Company estimates that up to $265 billion worth of care services for certain Medicare beneficiaries could shift from medical facilities to homes by 2025—without a reduction in quality or access. This critical change in reimbursement policies enables healthcare providers to cost-effectively expand care access to more patients while eliminating the need for substantial investment in building or acquiring more inpatient facilities.

Consumer expectations for improved care experiences are also accelerating interest in hospital-at-home models. Although hospitals are the gold standard of care for acute illness in the U.S., they can be expensive and uncomfortable, especially for older patients who frequently suffer delirium, contract hospital-associated infections or decline in function.

The digital technology edge

The most powerful drivers for digital home hospital adoption, however, are advances in telehealth, remote monitoring and emerging digital technologies that facilitate high quality, cost-effective care beyond hospital walls.

First, continuous remote patient monitoring (cRPM) sensors are improving in quality and data capture while also becoming smaller, easier to wear and more economical. Second, the pervasive use of smartphones and mobile apps allows clinicians and patients to stay in contact and share vital health information. Third, volumes of data can be stored in the cloud and accessed in near-real-time. These solutions are designed not only to emulate the care that patients receive in a hospital, but to enhance it. And last, FDA-cleared artificial intelligence (AI) algorithms can be used to analyze multivariable patient data and support the delivery of personalized insights that can transform care. In fact, the Deloitte Center for Health Solutions identified AI and machine learning as significant transformers of healthcare in the next 10 years.

Patient-centric care 

The digital home hospital model provides an outstanding opportunity for hospitals to offer patient-centric care, which encourages active collaboration and shared decision-making between patients, families and clinicians to design and manage customized and comprehensive care plans.

For example, many in-patients receive periodic visits in their room from clinicians to spot check their vitals, whereas digital home hospital patients can be conveniently monitored, continuously, and often passively. This way, clinicians can closely track key health indicators, receive alerts to early signs of potential deterioration and check in with patients through a mobile app, text or video call. This allows the right care to be provided to the right patient at the right time—focusing on both the patient’s physical comfort and emotional well-being.

In the digital home hospital model, patients—especially those with a chronic condition such as heart failure or COPD—feel more confident and comfortable that they are being constantly monitored, as do their family members and others who play a role in decisions and communication about their care. Clinicians now have access to patient-reported outcomes and hard data to make informed care decisions, such as whether to continue monitoring and treating patients at home or admit them to the hospital. The ubiquitous use of EMRs across health systems also helps ensure that digital home hospital care delivery can be entered into patient records to keep all care providers updated on a timely basis.

The digital home hospital environment also can support improved medication adherence, crucial to patient outcomes. For example, adding a layer of cRPM on top of multiple daily clinician visits, as part of the digital home hospital model overall, provides an opportunity to monitor patients for changes in vital signs that might indicate side effects or non-compliance.

Hospital at home in action

Let’s consider a hypothetical scenario to illustrate the benefits of the digital home hospital model. A 70-year-old woman with NYHA Class II Heart Failure and atrial fibrillation (afib) visits the ED with palpitations, anxiety and shortness of breath.

The ED physician determines she is having poor rate control of her afib and changes her medication dosage. After a consult with the hospitalist, she is admitted to a hospital-at-home program (instead of an inpatient bed) and receives training on the cRPM solution, which includes a chest patch and mobile smartphone app.

The app links her to a clear explanation of her new medication regimen and information about her condition to share with family members. Her home health nursing team sends messages to remind her to respond to daily check-in surveys.

When the patient overexerts herself a couple of days later, the app immediately asks her to answer a few questions and shares the results with her care team. A nurse reaches out to further assess her status, advising rest and re-educating on when to take her medication—avoiding an unnecessary ED visit. Moving forward, the home health team continues to monitor her activity, vital signs and progress as she engages in her rehab exercises on her app.

A positive outlook 

All signs point to the hospital business model of the future looking radically different than today’s version. Digital home hospital solutions are going to be pivotal in their ability to improve the patient experience. With the right technology, clinicians can deliver hospital-level care to more patients in the right place—which for many, is in the comfort and familiarity of their own home.