For decades, healthcare leaders have recognized the immense potential of hospital-level care at home. However, systemic barriers have largely kept this vision from becoming a reality. Today, a confluence of factors has aligned to finally make this long-sought goal achievable.
A significant factor driving this shift is the development, validation, and commercialization of hospital-at-home models. Leading health systems now recognize the opportunity to improve patient care options while managing pre-existing capacity constraints. These issues were already evident before the pandemic, but COVID-19 served as a catalyst, exposing the limitations of the U.S. healthcare infrastructure during a public health crisis of unprecedented scale. Concurrently, societal comfort with remote services grew, driven by the widespread adoption of virtual platforms such as Zoom, normalizing the concept of receiving traditionally in-person services from home.
Early hospital-at-home programs provided anecdotal evidence of improved patient outcomes, which were later validated by peer-reviewed research demonstrating parity or better outcomes compared to traditional inpatient care. These findings helped to solidify confidence in the model’s effectiveness.
And then there was the waiver.
The Acute Hospital Care at Home (AHCaH) waiver, implemented during the COVID-19 pandemic, has been instrumental in overcoming a major hurdle: reimbursement. Under the waiver, hospitals receive the same payment for inpatient services delivered at home as they do for traditional hospital stays. This financial parity removed a key disincentive for providers to adopt the model.
Moreover, the waiver has catalyzed a cultural shift within healthcare systems. By providing a framework and financial support, it has encouraged hospitals to embrace a patient-centered approach and reimagine how care is delivered. This shift in mindset has been crucial in driving physician buy-in, which is essential for the successful implementation of hospital at home.
Another critical success factor has been the growth of a robust evidence base. Decades of research, including randomized controlled trials, consistently demonstrate the safety, effectiveness, and patient preference for hospital at home. The 2024 CMS report of hospital at home programs operated under the waiver highlighted lower costs, equal or better outcomes, and higher patient satisfaction compared to traditional inpatient care. Cleveland Clinic has recently published results showing improved outcomes for heart failure patients in hospital at home. This growing evidence base has helped to alleviate concerns about quality and outcomes, bolstering confidence among providers and patients alike.
However, safely and effectively providing hospital-level care at home goes beyond simply replicating existing services in a different setting. It requires a sophisticated logistical and technological infrastructure to ensure seamless and timely delivery of care 24/7/365. This includes everything from medication dispensing and lab testing to remote patient monitoring and emergency response capabilities. Most importantly, systems need the ability to track logistics from the physician order to delivery in the home. Medically Home’s Cesia software provides exactly this capability to our partners, allowing them to document and order care in the native EHR while care is dispatched to the home, with over 200,000 orders fulfilled in the home in the last year on demand and in a time frame equivalent to the hospital.
Advancements in telehealth, remote monitoring technologies, and integrated care delivery platforms have made this complex coordination possible. These technologies allow for real-time communication between patients, caregivers, and the care team, facilitating continuous monitoring, timely interventions, and proactive care management.
The success of the AHCaH waiver program is evident in its rapid growth and positive outcomes. As of July 2024, CMS had approved 332 hospitals for participation, and 93% of admitted patients resided in urban areas. Studies have shown that patients treated under the waiver experienced shorter lengths of stay, lower Medicare spending in the 30-days post-discharge, and high satisfaction rates.
Medically Home has played a significant role in providing comprehensive, scalable solutions for hospital at home. We enable health systems to provide acute care in the home through a program that encompasses the full spectrum of services needed to deliver high-acuity care in the home, from virtual physician visits and in-home care to medication management, lab testing, and emergency response.
The convergence of these factors – a supportive reimbursement mechanism, physician buy-in, a robust evidence base, and advanced logistics technology – has created a fertile ground for the expansion of hospital at home.
While the AHCaH waiver has been instrumental in accelerating this progress, the long term viability of hospital at home hinges on the creation of a permanent reimbursement pathway. This will provide the long-term stability and predictability necessary for healthcare providers to fully integrate hospital at home into their care delivery models and to continue innovating and improving the model.
A permanent program would also allow for the development of standardized quality metrics and data collection protocols, facilitating ongoing evaluation and improvement of the model. This will further enhance confidence among patients and providers, driving broader adoption and ensuring the long-term sustainability of hospital at home.
The success of the AHCaH waiver program demonstrates that hospital-level care at home is no longer a futuristic concept but a viable and beneficial reality. By building upon the lessons learned and addressing remaining challenges, we can create a healthcare system that prioritizes patient-centered care and leverages the power of technology to deliver high-quality, cost-effective care where patients want it most – in the comfort of their own homes.