Hospital at home playbook: Lessons from Mayo Clinic, Michigan Medicine and Presbyterian Health

Hospital-at-home programs are proliferating across the country, as more health systems partner with companies like Medically Home or create their own internal programs. Waiver flexibilities spurred by the pandemic have also made such programs more viable to hospitals. 

Getting a program up and running though is no easy feat. Becker's spoke to three health systems that have successfully launched hospital-at-home programs and agreed to share advice and insights on their efforts. 

Michael Maniaci, MD. Physician leader at Mayo Clinic Advanced Care at Home (Rochester, Minn.).

Question: Why did you decide to start the program? 

Dr. Michael Maniaci: Even before the onset of the COVID-19 pandemic, Mayo Clinic was preparing to introduce Mayo Clinic Advanced Care at Home. Hospital-at-home models across the country have demonstrated success in providing safe care, reducing hospital readmissions, improving patient mobility, and achieving high levels of patient satisfaction.  

Q: What have the initial results shown? Has there been changes in key metrics like bed space or patient experience?

MM: Our Mayo Clinic Advanced Care at Home patients tell us how much it means for them to recover in the comfort of their homes. Caring for these patients in their homes also helped make additional hospital beds available for patients who needed them. This was very beneficial during surges of COVID-19 infections and will continue to help going forward.   

Q: What advice would you give to hospitals looking to establish a program of their own?

MM: Simulations, practice scenarios and ongoing clinical skills training are essential for providing in-home care. We have found it helpful to continue this training beyond the launch of the program.    

Elizabeth De Pirro, MD. Medical Director of the Hospital-at-Home program at Presbyterian Healthcare Services (Albuquerque, N.M.).

Question: Why did you decide to start the program? 

Dr. Elizabeth De Pirro: Presbyterian was one of the earliest adopters of Hospital-at-Home, starting our program in 2008. Our leadership at the time saw that this was an innovative and successful program for acutely ill patients who could be treated and recover in the comfort of their own homes, with pets and family nearby for support. Caring for these more stable patients in the home setting would also open additional inpatient beds for the more seriously ill.

Q: What have the initial results shown? Has there been changes in key metrics like bed space or patient experience?

EDP: We admit patients to Hospital-at-Home with seven diagnoses, such as chronic obstructive pulmonary disease and community acquired pneumonia. Our results show higher patient satisfaction, lower rate of falls, reduced mortality and 42 percent lower costs than what we would expect for hospitalized patients with similar conditions. 

Q: What advice would you give to hospitals looking to establish a program of their own?

EDP: The most important consideration is to decide which patient population you wish to serve.  How will Hospital at Home help provide excellent care to this population and who will be your partners in developing this plan?

Next, assembling your team is of critical importance. You need providers who are willing to work out of their car and drive with an assortment of medical supplies to see patients in their home. You will need nurses who are comfortable working independently even when unexpected situations develop. You also need to consider whether additional contracted services are needed to provide care to this population.

Grace Jenq, MD. Associate Chief Clinical Officer, Post-Acute Care Services at Michigan Medicine (Ann Arbor).

Question: Why did you decide to start the program? 

Dr. Grace Jenq: We started our journey with hospital care at home in August of 2018. It was a partnership with Blue Cross Blue Shield of Michigan and we started our pilot for hospital care at home in July of 2020. So it took two years to get it off the ground and develop all the different pieces to be able to support enrolling patients. Our goal is to continue to grow the program, we have a capacity issue here at University of Michigan Hospital, that is no different than lots of different other academic medical centers. What we recognize is that there are patients who are in our hospital beds, who can receive very basic IV medications, IV fluids, laboratory tests, and a combination of in-person and virtual visits in the home that are equal to what they get in the hospital.

Q: What have the initial results shown? Has there been changes in key metrics like bed space or patient experience?

GJ: We've had actually zero readmissions, zero ED utilization, patient satisfaction that has been outstanding for all of them. We've had no adverse events. So even though we don't have as many numbers [of patients] as other institutions, certainly just with our pilot, it's been very, very promising in terms of the outcomes.

Q: What advice would you give to hospitals looking to establish a program of their own?

GJ: I think one of our key pieces is having this be the strategic initiatives of the year, so the entire health system has to be completely committed to driving this hospital care home program forward, or else, you will just end up with pieces, here and there where people are willing to develop, but then you're going to be held up in another area. We need everyone, not just the doctors, not just the nurses, but you need everybody in HIT  to build platforms in a timely manner, you need people in regulatory compliance, to move forward to make sure that we're doing things correctly. You can't underestimate how many hundreds and hundreds of hours that are put in at the system level, just to be able to enroll even just a few patients right off the bat.  It takes everybody so you have to have the commitment of the entire health system in order to get something like this off the ground.

 

 

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