Stanford Health Care’s hospital-at-home program was never supposed to look like a traditional hospital-at-home program.
California regulations prevented the health system from fully operating under CMS’ Acute Hospital Care at Home waiver model, forcing leaders to rethink how care could extend beyond the hospital walls. One year later, Stanford executives said that limitation may have become the program’s biggest advantage.
Instead of building a rigid acute-care-at-home structure, Stanford created a flexible, ambulatory-based transitional care model designed to shorten hospital stays, ease discharge bottlenecks and support patients at home after hospitalization. The program has since scaled to a daily census of 45 patients and enrolled more than 1,000 patients in its first year.
“Rather than asking, ‘What conditions can we manage?’ we started asking, ‘What can’t we manage?’ That turned out to be a much more useful framework,” Ron Li, MD, medical informatics director for digital health at Stanford Health Care in Palo Alto, Calif., told Becker’s.
That shift in thinking helped Stanford broaden the types of patients it could support while avoiding some of the operational rigidity other health systems face under the federal waiver model.
The program launched with 10 patients on its first day and is expected to reach a census target of 54 patients by the end of Stanford’s fiscal year, according to Sophia Loo, senior director of Stanford Health Care Home Program.
“We were given some aggressive goals by senior leadership,” Gretchen Brown, MSN, RN, vice president and chief nursing information officer at Stanford Health Care, said. “When we talked to other programs across the United States, they were a little surprised at how high our target was.”
Unlike many hospital-at-home programs that launch around service lines or departments, Stanford organized its model around care pathways.
“We went live with care pathways,” Ms. Brown said. “The issues of having surgery and stopping your anticoagulation, or having your diabetes exacerbated while you’re in the hospital, that’s pervasive across many different service lines.”
That approach helped Stanford identify patients who no longer needed to remain physically in the hospital but still required clinical oversight, medication adjustments or follow-up coordination before fully transitioning back to traditional outpatient care.
Dr. Li said the flexibility of Stanford’s model has been critical to scaling the program.
“The care gaps exist in different ways,” he said. “For one patient, we might want to check in multiple times a day. For another patient, maybe we just have to facilitate care coordination. In both cases, we’re probably saving an inpatient day.”
Because Stanford’s program does not operate under the CMS waiver, leaders said they were also insulated from operational disruptions that affected some hospital-at-home programs during periods of waiver uncertainty, especially when the government shutdown earlier this year caused some health systems across the country to pause their programs.
“When I spoke to my colleagues about hospital-at-home programs, they were significantly impacted,” Ms. Loo said. “They had to shut down the program or really scale down significantly, whereas we were not impacted at all.”
The flexibility also enabled Stanford to expand geographically by partnering with home health agencies rather than building extensive in-home infrastructure internally.
“As an academic medical center that takes patients from all over California, we need to be able to send them back to all over California,” Ms. Brown said. “We’ve really been able to grow very quickly to 10 neighboring counties because of this network.”
Beyond operational gains, leaders said the model has resonated strongly with patients.
“Our patients that have been enrolled in our program, they don’t want to leave,” Ms. Loo said. “We have to remind them the program is short term.”
Dr. Li said the program addresses a common but often overlooked challenge in healthcare: the anxiety patients experience when leaving the hospital.
“For many patients, hospitalization is frightening and unfamiliar,” he said. “When we offer this program, you can often see a sense of relief.”
Stanford leaders said physician trust and grassroots clinical engagement were essential to the program’s internal adoption.
“It’s really important that you have a physician-led program,” Christopher “Topher” Sharp, MD, chief medical information officer at Stanford Health Care, said. “These programs happen at the level of direct patient interaction, not at the level of some higher-order administration.”
For other health systems exploring similar models, Stanford leaders recommended starting with low-risk operational investments rather than waiting to build a fully mature hospital-at-home infrastructure.
“This is really a low-risk, no-regrets consideration,” Dr. Sharp said. “Hospitals can leverage what they already have in place, whether it’s telehealth, fantastic nursing, physician leadership or their understanding of community assets.”
Dr. Li said Stanford’s willingness to experiment incrementally helped accelerate growth.
“One reason we’ve been able to grow is that the cost of experimenting is very low for our program,” he said. “We get to create what many people believe is probably a version of the future for hospitals.”
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