What's the future of hospital at home? 6 innovation execs weigh in

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The pandemic accelerated "hospital at home" programs, which use remote monitoring and telehealth technologies to provide patients with hospital-level care without the risks and costs associated with hospital stays. 

Below, six health system innovation executives discuss what excites them most about hospital at home and how technology can shape the future of the care model.

Editor's note: Responses have been edited lightly for clarity and style.

Eduardo Conrado. Executive Vice President and Chief Strategy and Innovation Officer at Ascension (St. Louis). What excites me the most about hospital at home is in a word, innovation. Our teams are continually looking for ways to transform and improve access to and delivery of healthcare services across our communities, including home-based care. By applying a personalized and compassionate strategy to emerging technology, we're enabling seamless, easy access to care when and where it’s needed. 

Today, the patient journey now includes multiple avenues for receiving care at home, such as the ability to video chat with a clinician or be closely connected to clinical resources while recovering at home. Especially important is how digital service innovations allow easier access to care for those who may not be within driving distance of a healthcare facility. 

We feel we're just scratching the surface on our capabilities to deliver care to all, and we're excited about future innovations and digital tools that will expand options for telehealth services within the communities we serve – especially for those most vulnerable among us.

Daniel Durand, MD. Chief Innovation Officer at LifeBridge Health (Baltimore). Virtually everyone is excited about the dawning of the age of the hospital at home. Physicians and patients see the opportunity for improved experience and outcomes by keeping patients who don’t need the hospital out of those buildings, which are essential for many types of care but also carry risks and costs that are best avoided by those who don’t need to be there. Payers and the government see tremendous value gains through the avoidance of the fixed costs of hospital-based care, much of which are driven by regulation and are thus unlikely to change regardless of the tech innovation landscape. Entrepreneurs and start-ups see that there is ample funding and a huge runway for growth as the population ages over the next three decades.

What excites me the most about this movement is how rapidly innovations in remote monitoring and point-of-care diagnostics are expanding its potential. Advancements in sensor technology, miniaturization and machine learning are allowing for real-time remote monitoring of physiological parameters that traditionally could only be measured with costly hospital-based labs and equipment. I'm referencing breakthroughs like pocket ultrasound devices, portable MRI machines, non-invasive blood chemistry assessment, multiparametric cardiopulmonary testing and even smart toilet seats that can help monitor congestive heart failure patients.  

As these devices proliferate, machine learning and AI will be increasingly necessary to monitor the resultant data feeds and detect which patients are at risk for decompensation and who might need to be admitted to a traditional hospital setting. Companies like DispatchHealth, Biofourmis and others are actively deploying delivery models that integrate many of these components.  The result will be an increasingly versatile model that will help keep large numbers of patients with frail health and/or chronic conditions safely "liberated" from the hospital and able to enjoy a far higher quality of life at a much lower cost.

Richard Zane, MD. Chief Innovation Officer at UCHealth (Aurora, Colo.). The potential for the development of hospital at home is far greater than simply allowing patients to convalesce at home in a more intimate, familiar and less costly environment. 

What a hospital at home program can evolve to is an out-of-hospital environment — home or anywhere — where the rational deployment of technology (remote patient monitoring, including behavioral activation, artificial intelligence and prescriptive intelligence combined with the judicious intersection of human adjudication) will recognize when patients with complex medical conditions or who are immediately post-procedure show signs of deterioration far before they are traditionally symptomatic. This will allow for earlier and likely less complex intervention, avoiding progression of illness and need for acute, episodic and/or unscheduled care.   

Nick Patel, MD. Chief Digital Officer at Prisma Health (Columbia, S.C.). A strong hospital at home program that leverages the appropriate personnel, data, inclusion criteria and technology allows for decompression of busy hospitals and more importantly, provides the equivalent level of care at the fraction of the cost. Technologies such as  remote patient monitoring, enhanced video visits and automation provide providers and patients with more options for care delivery and reduce the risk of hospital acquired infections.

Tom Andriola. Vice Chancellor of IT and data at University of California Irvine. What excites me is just the open mindedness to think about creating a more patient-centric experience. We’ve seen that the technology can work if it is implemented properly; the pieces are there. It’s a matter of thinking about the patient, the caregiver, the different interactions and the possible scenarios that you’ll have to accommodate. When we can put it together in the right way, we can provide the patient with the opportunity to receive care, recover or maintain their chronic condition from the comfort of their home and familiar surroundings. I consider that progress in patient centricity.

The way I think about things, tech is not leading the way. The availability of technology is opening people's minds on how we might deliver services differently, consider a more patient-centric experience, and discuss where this type of care is appropriate and where not.  Technology is the enabler, but clinicians and caregivers will always be in the lead.

Pankaj Jandwani, MD. Chief Innovation Officer at MidMichigan Health (Midland, Mich.). It is exciting to see how the pandemic, presenting us with some of the most significant challenges, motivated us to be innovative, build better processes and capabilities and figure out how to treat more of our patients in the comfort of their own homes. I am also pleased to see more data on the safety and value of hospital at home, which perhaps also motivated CMS to recognize this model for better reimbursement. 

I am proud of the accelerated learning and implementation of hospital at home at MidMichigan Health, starting with treating COVID19-positive patients in their homes. This model perfectly aligns with our goal to create a system of care to provide healthcare close to the patient's home while maximizing quality and access. MidMichigan Health currently serves over 23 counties of rural Michigan, and transportation, especially during winter, is challenging for many patients and families. Building on the hundreds of thousands of miles saved by our patients through virtual visits, hospital at home models allow us the opportunity to achieve zero harm by reducing adverse events related to unfamiliar hospital environments.

An integrated EMR across the care settings that provides objective scores and tools to stratify patients based on their risk of clinical deterioration, re-hospitalization and mortality is a must to correctly identify patients who will safely benefit from this model and manage their care. To that end, we have prioritized training our clinicians and standardizing processes to effectively leverage remote monitoring and securely communicate with our patients. We are exploring solutions that integrate data from these devices into the EMR and provide timely decision support in a predictive manner to improve patients' outcomes. Additionally, we continue to improve on educating patients and families on use of remote monitoring devices and collaborating with our community partners to improve broadband availability in our rural communities.

 

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