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Here in New England, health care is increasingly expanding beyond hospital walls. “Patients like being at home,” says Dr. Constantinos “Taki” Michaelidis, medical director of Hospital at Home at UMass Memorial Health.
Since the Acute Hospital Care at Home waiver program was announced in November 2020, health system leaders have begun to embrace at-home health care delivery as they continue to feel the strain of rising patient volumes and staff shortages.
“If we can have patients recover from the comfort of their own home, then it’s a win,” Dr. Michaelidis says. “Studies show that hospital-at-home programs improve patient outcomes and increase patient satisfaction. Patients can get better sleep and experience fewer disruptions at home, which can help with the healing process.”
UMass Memorial Health launched its Hospital at Home program in August 2021, allowing eligible patients to receive high-quality, hospital-level care in the comfort and familiarity of their own home. The program offers at-home nursing care, telemedicine visits, delivery of food and supplies, transportation for testing, and more. Similar shifts to at-home care are taking place across the health care ecosystem, from senior care to the management of chronic conditions.
An estimated $265 billion worth of care for Medicare fee-for-service and Medicare Advantage beneficiaries could transition to the home by 2025, according to McKinsey. Many hospitals have a strained patient-to-bed ratio, resulting in long wait times in the emergency room, overcrowding, and delays in care. Hospital-at-home programs help to provide the same level of inpatient care to those at home, while also alleviating the stress on ER departments.
Hospital-at-home programs are generally good for patients with conditions that have low rates of complications, according to Dr. Michaelidis, including certain skin infections; urinary tract infections; mild COVID-19 cases; influenza; congestive heart failure exacerbation; and acute kidney injuries.
While some may have concerns around safety, hospital-at-home program data show a reduction in hospital readmission rates and lower depression and anxiety scores.
“You are less likely to see falls or hospital-acquired infections in the home environment,” says Dr. Michaelidis. “We provide the same services that a patient would receive in a traditional hospital without the associated risks.” Plus, at-home patients have a much lower probability of being admitted to a skilled nursing facility post-home hospital stay.
Technologies like telehealth, remote patient monitoring and automation are the central nervous system of at-home care programs. With more generations embracing technology, especially older populations, providers now have the opportunity to deliver quality care in the home.
For patients with chronic conditions, investments in technology and innovations are enabling more care to take place outside of the hospital. Home dialysis has been a major focus for Outset Medical over the last few years. The company rolled out the Tablo Hemodialysis System that gives patients the option to do dialysis treatments in their own home. Boston-based Biofourmis is also expanding its AI-based virtual care platform to include chronic care or longitudinal disease management capabilities. The platform can manage multiple conditions at once, like diabetes and hypertension, while tailoring the cadence of services to ensure the patient is getting the right care at the right time.
Dr. Michaelidis also says that it’s important to look at any gaps in home-based services and partner with community health organizations. For example, hospitals can handle laboratory and imaging services for at-home patients, and then offer services like physical therapy through ancillary service providers.
Health insurers also offer various types of at-home care services that can reduce the need for in-person visits. Point32Health companies Harvard Pilgrim Health Care and Tufts Health Plan both offer eligible members access to Landmark Health’s 24/7 coordinated care program, which supports chronically ill seniors with complex health needs. The Landmark care model delivers medical, behavioral, social, and palliative care to individuals, where they are and when they need it.
Room for Growth and Expansion
Home health care is ripe for growth. Many services, like ER and mental and behavioral health visits, have significantly increased since the start of the pandemic. Because of expanded capabilities, many at-home care programs can treat these conditions, but it’s going to require proper scaling.
As the health care needs of the U.S. population continue to evolve, health care organizations will need to figure out ways to deliver more services in the home. By 2030, a quarter of all boomers will live with diabetes, and 60 percent will need treatment for multiple chronic disorders. Addressing these needs will require hospitals to embrace a multifaceted approach to care, which can be attained through care programs at home.
“The average age of our patients in the Hospital at Home program is 65,” says Dr. Michaelidis. “Facilities that care for geriatric populations might send 15 to 20 percent of patients to a skilled nursing facility, but our hospital is sending about 2 percent.”
We’re also starting to see more long-term care conducted in home settings. Nearly 90 percent of Americans would rather care for their elderly loved ones in their own home instead of moving them into a facility, but home care can be taxing on family members. As many as 47 percent of Medicare beneficiaries are sent home from the hospital with at least one unmet need related to activities of daily living. With at-home care, patients can reduce the risk of readmission and achieve the same outcome that they would have in a facility.
“Over time, we’ll continue to expand and grow the at-home hospital program to care for an increasingly large percentage of patients,” says Dr. Michaelidis. “When you build and add services, then you have greater capabilities of treating a wide range of conditions. For instance, we didn’t have a cardiac telemetry service when we launched in August 2021. Therefore, patients who required this service couldn’t be admitted to our at-home program. This service will soon be offered through our program, which will allow us to treat a broader range of patients.”
In the short term, however, there’s a very pressing need for urgent congressional action surrounding the CMS Acute Hospital Care at Home waiver, which is currently set to expire at the end of the public health emergency. “Our most vulnerable patients with traditional Medicare or Medicaid are now routinely offered the choice to receive care in the comfort of their homes,” says Dr. Michaelidis. “With the end of the Federal Public Health Emergency, this program will expire, and patients will lose access to this safe and effective care option, which is why we need to act now.”
Here to Stay
As more care is transitioned into the home, health care providers are optimistic about the quality of the experience being delivered to both the patient and the caregivers. “Patients and families are increasingly demanding these types of programs. It’s an exciting time for health care as we can now build virtual hospital beds in patients’ homes. We’ll start to see more at-home programs being offered, while also seeing an increase in the number of services that existing programs offer over the next few years,” says Dr. Michaelidis.
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