As hospital-at-home programs grow across the U.S., health systems are rethinking how they staff these services to ensure sustainability, scalability and provider buy-in.
Early models relied heavily on in-person care, but many programs are shifting toward hybrid or virtual-first approaches that still maintain high-touch in-home services.
“In Massachusetts, we benefit from a relatively stable regulatory environment that’s allowed our clinical model to remain consistent and effective,” Stephen Dorner, MD, chief clinical and innovation officer of Somerville, Mass.-based Mass General Brigham Healthcare at Home, told Becker’s. “When we first launched, one unique aspect of our model was that providers went into patients’ homes alongside the virtual care component. Over time, we’ve seen growing comfort — among both patients and clinicians — with virtual care.”
As a result[[, Dr. Dorner said there’s been a shift toward more virtual provider care. Still, nurses and paramedics with the health system’s hospital-at-home program continue visiting patients at least twice daily, and providers make at least one in-person visit per patient.
But with growing comfort with virtual care, Mass General Brigham is seeing “new efficiencies,” Dr. Dorner said, which allow the system to serve more patients while maintaining quality care.
“We’re also seeing trends around mobile diagnostics and therapeutics — things like bedside lab testing, remote pump programming, and smart medication dispensing. These tools will expand what our teams can do in the home and evolve our workflows,” Dr. Dorner said.
Newark, Del.-based ChristianaCare is also expanding its team and introducing new roles to support patient intake and logistics.
“We are not only increasing our staffing levels but also evolving our staffing model to enhance workflow and resource efficiencies,” Sarah Schenck, MD, executive director for ChristianaCare’s Center for Virtual Health, told Becker’s.
Dr. Schenck said the health system’s in-home paramedic workforce is growing. She also noted that ChristianaCare created a nursing role focused on guiding patients into the program and co-developed a logistics platform to help with daily scheduling for in-home care teams.
“This role has proven essential for the ongoing growth of our program, because it’s such a new concept for patients and even many physicians,” Dr. Schenck said.
Other systems are investing in support infrastructure to keep pace with rising patient volumes.
“At University of Chicago Medicine, as we scale, we require more dedicated administrative and logistical support than what was necessary during the bootstrap phase,” Cheng-Kai Kao, MD, chief medical information officer at University of Chicago Medicine, told Becker’s.
To accommodate a higher patient census, the health system also plans to hire more full-time equivalents across various roles to ensure it can continue providing necessary care and support.
Meanwhile, Pittsburgh-based Highmark Health and its affiliate Allegheny Health Network have prioritized provider education and trust-building to grow adoption.
“We’ve learned that keeping clinicians’ workflows simple is key,” Mona Siddiqui, MD, senior vice president of home and community care at Highmark Health, told Becker’s. “We rely on backend analytics to help flag appropriate patients and have a dedicated person to explain the program to patients, which significantly improves acceptance.”
Allegheny Health Network also realized that embedding advanced practice providers in hospitals and conducting in-person outreach to emergency departments and hospitalists helped generate referrals.
“The hospitalists — the quarterbacks of inpatient care — were a key audience,” Vicenta Gaspar-Yoo, MD, senior vice president of care continuum and transitions, told Becker’s. “We conducted in-person outreach to socialize the program. That’s how we gained buy-in.”
Hospital-at-home programs have grown significantly since the Centers for Medicare & Medicaid Services launched the Acute Hospital Care at Home waiver in 2020. As health systems continue to expand these offerings, leaders say staffing models will keep evolving alongside new tools and patient expectations.
“This is about refining what works,” Dr. Dorner said. “Not rethinking it entirely.”
