The current state and future promise of inpatient care inside patients’ homes: 5 things to know

The hospital-at-home model has been shown to satisfy patients with quality care and experiential satisfaction while pleasing administrators and payers with reduced costs. 

What’s more, “HaH” does no worse than conventional hospitalization with mortality, length of stay and readmission rates. 

So why has it not spread like wildfire? 

Researchers at Mass General Brigham’s Healthcare Transformation Lab in Boston have investigated and come up with some answers.

Health Policy and Technology published their findings July 23. 

Half-decade waiver: Just what the HaH doctor ordered? 

Jared Conley, MD, PhD, MPH, and colleagues report that, along with known technical barriers like connectivity and reliability, a number of sneakier snags are at play. 

These include interoperability gaps, fragmented vendor ecosystems and limited EHR integration.

What all such issues may have in common, Conley and co-authors suggest, is a non-technical hurdle: the “substantial impact the uncertain reimbursement landscape has for HaH sustainability, which has consequently limited the health technology industry from fully engaging in the HaH space.”

The good news is that, earlier this year, Congress voted to extend CMS’s hospital-at-home waiver for five years. This will let individual hospitals bill Medicare for many HaH services through September of 2030. 

With the move, industry and healthcare leaders are increasingly incentivized to develop and implement technologies that expand HaH care, Conley and team point out. 

Aficionados light the way  

The hospital at home model leverages the convenience of daily in-person visits, virtual doctor check-ins and digital tools to deliver care on par with conventional inpatient care.

For the present research into what ails HaH and how best to fix it, Conley and colleagues surveyed American and Canadian experts with the Hospital at Home Users Group (HaHUG) and its associated HaHUG Technology Council. 

Upon analyzing the responses, Conley et al. came up with a number of observations and recommendations for extending HaH’s accessibility and reach. 

Here five excerpts from their discussion section.  

1. HaH evolved in a very different technology environment, and only recently have clinicians begun to leverage newer digital tools to support the model. 

“The resulting variation across programs reflects differences in local market context, program size and implementation priorities, which have produced diverse approaches to technology adoption,” the researchers write. 

‘As HaH matures, greater standardization and more consistent tech-enabled workflows will likely improve scalability and reliability, and we are hopeful our study furthers this evolution.’

2. In the near term, health systems should prioritize interoperable solutions that are also EHR-integrated, as well as automating workflows to optimize operational efficiency. 

“Vendors should build solutions that integrate seamlessly with existing provider tools and workflows,” Conley and colleagues advise. And in the meantime?

 ‘Policymakers can encourage innovation and growth through more permanent payment models with practice standards tailored to HaH.’

3. In the longer term—as technological capabilities like predictive analytics and AI/ML become more advanced—solutions may have the potential to increase screening efficiency, monitoring capabilities and improve care coordination. 

These kinds of advances will help expand eligibility for HaH across wider geographies, diagnoses and clinical acuities, the researchers write. Between now and then, they note, “we should remain cautiously optimistic around the power of AI in its current state given risks such as bias, variable performance, privacy, regulatory uncertainty and poor workflow integration.” 

‘Continued efforts to mitigate these challenges are imperative as tools are developed and deployed.’

4. By elucidating the current operational experience, challenges, and opportunities in tech-enabled HaH across the U.S., Conley and colleagues state, “we hope to aid in the development of a research and development (R&D) agenda that will be used by all stakeholders to guide future work.” 

In this vein, the HaHUG Tech Council is “actively pursuing a modified Delphi study as a next step to establish consensus-based priorities for such a tech-enabled HaH R&D agenda,” the authors report. 

“For the appropriate patients,” they add, “HaH care has emerged as a promising model for delivering acute care to many eligible patients but remains limited in scope.”

‘We believe that through tech-enablement—along with clinical process development and dedicated clinicians—there is substantial opportunity to further expand HaH’s reach and impact.’

 

5. Although exploratory in nature, the present findings “identify several challenges in implementing such technologies into HaH clinical workflows, along with vast opportunities to further enable the HaH care model through technological innovation,” Conley and team write. 

‘The subsequent development of a R&D tech-enabled HaH [policy] agenda is warranted to bring together relevant stakeholders to realize this opportunity, especially in the setting of recent accelerated adoption in the U.S. and globally due to new payment models that allow for a more home-centered, hospital-supported acute care delivery system.’

The study is posted here (behind paywall).