Hospital-at-home programs gained significant traction during the COVID-19 era, spurred by CMS’ 2020 waiver program to ease hospital capacity. What began as an emergency measure has since evolved into a cornerstone of modern healthcare delivery.
Initially launched as pilots, hospital-at-home models quickly became strategic priorities for many health systems. By 2025, they are firmly established across numerous organizations and are entering a new phase. According to health system leaders who spoke with Becker’s, this “Hospital-at-Home 2.0” era will focus on scaling daily admissions, broadening patient eligibility, and preparing for potential shifts in federal reimbursement.
Strategic scaling and refined patient targeting
At Pittsburgh-based Allegheny Health Network, growth is a primary focus.
“In January 2024, we were averaging around seven to eight admissions a month. Now, we’re seeing about 40 admissions a month,” Vicenta Gaspar-Yoo, MD, senior vice president of care continuum and transitions, told Becker’s. “Our intent is to continue to build that.”
The health system is also refining its approach by targeting specific diagnosis groups, beginning with congestive heart failure. Since November 2024, it has transitioned non-complex CHF patients directly from the emergency department into its acute care-at-home program, bypassing inpatient admission.
Mona Siddiqui, MD, senior vice president of home and community care of Highmark Health, in which Allegheny Health Network is part of, told Becker’s the organization is positioned to scale due to solid infrastructure and self-reliance.
“We’ve done a good job identifying the right patients at the right time. We also don’t have to rely on outside vendors,” she said. “That puts us in a unique position to say, ‘We’re ready.’ And unlike many others in this space, we were actually profitable this year, so now we can think thoughtfully about growth and expansion — especially around the types of patients and specific conditions we bring into the home. It’s an exciting place to be.”
From foundation to full utilization
Somerville, Mass.-based Mass General Brigham, home to one of the country’s largest acute care-at-home programs, is shifting focus from building to optimizing.
“Over the last few years, we experienced a period of rapid growth where we focused on building the foundation — developing new care pathways and establishing all the necessary infrastructure, safety mechanisms and resource planning that come with launching a new model,” Stephen Dorner, MD, chief clinical and innovation officer of Mass General Brigham Healthcare at Home, told Becker’s. “Now that foundation is in place, the next phase is about maximizing its use.”
The system has built a 70-bed home-based unit and is working to fill it with patients who would otherwise require inpatient care.
“We’ve already expanded to care for post-op patients, cancer patients and individuals with postpartum hypertension,” Dr. Dorner said. “We’re exploring what other clinical conditions we can safely support at home so we can consistently operate at capacity.”
Full-continuum care and infrastructure expansion
ChristianaCare in Newark, Del., offers a broader look at home care strategy. The health system’s next phase focuses on delivering care across the full continuum through a centralized command center.
“A key component of our strategy is the Hospital Care at Home program, which includes a 24/7 command center that serves as the backbone of our home care delivery,” Sarah Schenck, MD, executive director for ChristianaCare’s Center for Virtual Health, told Becker’s.
The health system also launched a Skilled Nursing Facility at Home program using the same staffing, technology and workflows to maintain seamless care in the home.
Payer collaboration and financial sustainability
Meanwhile, at Chicago-based University of Chicago Medicine, the focus is on broader expansion and payer collaboration to cement hospital-at-home as the foundation of care-at-home offerings.
Cheng-Kai Kao, MD, chief medical information officer, told Becker’s the system is working with payers to expand insurance coverage and improve accessibility.
“This approach aims to enhance accessibility and ensure that more patients can benefit from receiving care in the comfort of their homes,” he said.
Policy uncertainty and future planning
Still, a critical concern looms: whether the federal government will extend the waiver that underpins the financial model for hospital-at-home. The Acute Hospital Care at Home waiver is slated to expire in September without further action.
“With the waiver’s potential sunset on the horizon, the question is: How do we take these care models we’ve built under a fee-for-service, DRG-based structure while operating under the waiver, and adapt them to support patients who fall outside of that traditional reimbursement model?” Dr. Dorner said. “We need to look at how this hospital-at-home infrastructure can support a wider range of patient types and clinical conditions — even those that may not qualify for traditional inpatient admission. These patients can benefit from this model just as much as those in brick-and-mortar facilities. That’s going to be an increasingly important part of the conversation.”
Dr. Dorner added that while he is confident the waiver will be extended, health systems must plan for broader use cases.
“How can we use these tools to care for more patients across the continuum?” he said.
Despite taking different paths, health systems are converging around the same core themes: scale, integration, adaptability and a broader vision for home-based care — especially as the value of these programs becomes increasingly evident in improved patient outcomes and reduced costs.
