More systems are leaning into virtual models that free up hospital beds, reduce costs, increase access and allow patients to receive home-based care. Here are three of the most popular ways systems are moving toward the future of healthcare.
Door-to-door care
Going back to the roots of healthcare, many systems are sending providers door-to-door to care for patients. These programs tend to be low cost since only the salary of the clinicians and supplies are required expenses, but have big impacts on reducing ED utilization.
Baltimore-based Johns Hopkins School of Nursing is taking primary care door to door through its Neighborhood Nursing pilot program. The program consists of a team of nurses and community health workers that make weekly visits to three apartment buildings in Johnston Square, a predominantly Black disadvantaged neighborhood. All visits are free to patients and are done in people’s homes, senior centers, lobbies, wherever the people can be found. The program has not only provided care, but expedited physicians appointments when needed. By 2025, the program hopes to expand their services to four neighborhoods — two within Baltimore, one in the suburbs and one in a rural area — and visit more than 4,000 people. The program staff are also receiving training on mental-health first aid and simple techniques of cognitive behavioral therapy.
Seattle-based UW Medicine has a similar program for heart failure patients. The Harborview Medical Center’s Community Heart Failure Program started in 2020 with 16 patients, half a day of care, and two clinicians: a nurse practitioner and a registered nurse. The clinicians drive to patients and meet them in shelters, cars, bus stops, or homes. These patients often face challenges with drug addiction, mental illness and homelessness. The pilot program was able to reduce all-cause hospital readmissions by 36.8%, decrease length of stay by 43% and decrease emergency department admissions by 26%. The program also increased outpatient care among this patient group by 73%.
Somerville, Mass.-based Mass General Brigham has expanded its hospital-at-home program to offer acute hospital care at a homeless shelter for veterans in Boston. Care includes 24/7 remote monitoring and communication capabilities as well as at least two daily visits from a paramedic or nurse and a minimum of one virtual or in-person appointment a day with a physician or advanced practice provider.
“The Home Hospital care model offers an opportunity to promote health equity. By bringing high-quality care directly to veterans experiencing homelessness…we can ensure they receive the necessary care and support, ultimately transforming their health outcomes and bridging the gap in care access,” David Levine, MD, clinical director for research and development for Mass General Brigham Healthcare at Home, said in a press release shared Nov. 6 with Becker’s.
Telehealth
Telehealth took off during the pandemic and has remained a vital way for rural patients to receive access to care.
In 2017, about 46% of hospitals offered at least one form of telehealth service. By 2021, that number rose to 72%, a July study found.
Telehealth allows patients to access healthcare at home and have access to specialists such as physical therapists and mental health providers — all with lower costs for care. It also reduces hospital costs and increases revenue by upping patient volumes and expanding access in areas where physician coverage is limited.
Hospital-at-home
Hospital-at-home programs have gained popularity in recent years, with more than 10 systems expanding or opening programs this year.
“Since, H@H has evolved into an effective approach to patient care that also enables providers to address the significant health equity and rural health challenges facing many patients by delivering essential, personalized health care directly to them,” Scott Rissmiller, MD, Chief Physician Executive, Advocate Health, said in an op-ed piece posted on Becker’s. “What’s more, H@H has proved to be a revolutionary tool in an increasingly unpredictable health landscape, allowing health systems to flex hospital capacity as seasonal needs dictate and bring hospital-level care to our patients in times of crisis, such as when Hurricane Helene devastated our North Carolina communities in September.”
Hospital-at-home programs are also popular among patients. Charlotte, N.C.-based Advocate Health found that nearly 95% of its hospital-at-home patients said they recommend the care model — 20 points higher than patients in brick-and-mortar facilities.
Here are just a few of the systems leaning into hospital-at-home care:
1. Mass General Brigham already has one of the largest hospital-at-home program in the country, with the capacity to treat 70 patients — and it has plans to grow to 10% of Mass General Brigham’s overall capacity, or about 200 to 300 patients. The program, which Mass General Brigham calls Home Hospital, typically treats patients with conditions like COPD flare-ups, heart failure exacerbations, acute infections and complex cellulitis.
2. Advocate Health has roughly doubled its hospital-at-home capacity in the past year, with the expectation to increase capacity to 100 patients by the end of 2024. The ultimate goal is to grow the program to 20% of inpatient bed capacity in the market, or 400 hospital-at-home “beds.” The initiative has expanded from treating common conditions such as heart failure, COPD and cellulitis to oncology and post-operative patients, including after bariatric surgery. Paramedics provide twice-daily in-person visits to patients’ homes
3. UMass Memorial has expanded its hospital at home to post-op patients following cesarean sections, urological and colorectal procedures, and rehabilitation care. Nurses and physical occupational and speech therapists work together on patient visits to offer subacute rehabilitation in their homes. The hospital-at-home program has an average daily census of 15 to 20 patients, while one to two patients are in subacute rehab at home. Since the program launched in 2021, the system has prevented about 16,000 inpatient bed days.
A threat to the future of telehealth, hospital-at-home
Hospital-at-home and telehealth are at risk of falling off at the end of 2024 if CMS and Congress do not take action.
CMS gave flexibility to hospitals to provide inpatient care at home during the pandemic. The rules were extended under the 2023 Consolidated Appropriations Act but expire Dec. 31.
“Hospitals have increasingly incorporated these services into their operations, which has helped to alleviate revenue and expense pressures,” according to Fitch. “Hospital financials have shown signs of improvement, although challenges lurk with increased Medicare payers as the U.S. population ages, shifts from inpatient to outpatient services and achieving sustainable levels of cash flow given high costs and fixed revenues.”
Recently, nearly 80 healthcare organizations called on Congress to extend telehealth flexibilities for at least two more years, warning that failure to do so would disrupt care and create uncertainty for patients and clinicians.
