Despite the hospital-at-home model existing for over 20 years, its popularity in the U.S. has been slow to gain significant traction. But the model made huge strides in 2019, with the implementation of a number of programs across the country.
Generally, hospital-at-home programs attempt to provide acute, hospital-level care in the home as an alternative to hospital admission, which can be costly. To do so, programs try to identify eligible patients whose medical conditions can be cared for in the home setting through coordinated nursing and clinician visits, plus necessary testing and treatment.
Even though hospital at home isn’t as prominent domestically as it is abroad, the past decade has seen organizations such as Highmark Health, DispatchHealth and others adopt the model.
Since the beginning, world-renowned Johns Hopkins — headquartered in Baltimore — has emerged as a pioneer in the space. Though Johns Hopkins doesn’t currently have an operational hospital-at-home program, the health system has been exploring the model since the early 1990s.
“I started working on hospital-at-home back in 1994,” Dr. Bruce Leff, a professor of medicine at the Johns Hopkins University School of Medicine, told Home Health Care News. “We did all of the development of the theory of the model, the background of the model, literature to support the model and we did the work to develop patient selection criteria.”
Additionally, Dr. Leff and the Johns Hopkins team spearheaded the work of figuring out what patients wanted from a hospital-at-home model, as well as clinical pilots.
As someone that has been at the forefront of the hospital-at-home model for the past 25 years, Leff has seen major progress in recent years.
“The amount of interest over the last year or two, especially in the last six to nine months, has been incredible,” he said. “I get anywhere between half a dozen and a dozen unsolicited emails or calls from health care leaders around the country wanting to learn more about hospital at home — and whether it is something their organization should be thinking about.”
Overall, interest in the model has been “exploding” from payers, health systems, “blue-chip” health industry leaders, physician groups, tech entrepreneurs, medical device companies and home health providers, according to Leff.
“Part of the reason why there has been a lot of interest lately is hospital capacity issues, the high cost of care and people not wanting to build new hospitals,” he said.
Health systems taking notice
Currently, Johns Hopkins coordinates research on hospital at home and has helped a number of health systems implement programs by providing advice and technical assistance.
In the midst of this up-and-coming era for hospital-at-home, additional companies have started to make their mark as well. Contessa, for example, helps its health system partners implement hospital-at-home programs while proving the model can be profitable.
Founded in 2015, Nashville, Tennessee-based Contessa calls its model “Home Recovery Care.” Again, Contessa’s hospital-at-home model is designed to provide hospital-degree care in the home at a more efficient cost.
Today, Contessa has partnerships with Marshfield Clinic Health System, CommonSpirit, Mount Sinai, Ascension Saint Thomas and Prisma Health. The company landed many of those relationships within the past year.
“Based on the interest that we have received, it’s pretty clear that health systems have taken notice,” Dr. Mark Montoney, chief medical officer at Contessa, told HHCN. “This is a model of care that is not only of interest to them, but they recognize this as a growing trend.”
One of Contessa’s most recent partners is Highmark Health, the Pittsburgh-based parent company of Highmark Inc., Allegheny Health Network and HM Health Solutions. The company is the second-largest integrated health care delivery and financing network in the United States based on revenue.
The companies teamed up on a joint venture in November. The JV gives select Highmark Inc. commercial health plan members access to hospital-level care in their homes, including telemedicine, in-home care and care management oversight.
“Right now is a good time to enter into the hospital-at-home model,” Monique Reese, senior vice president of home- and community-based services at Highmark, told HHCN. “Reducing any kind of unnecessary hospital readmissions and hospital-acquired infections became really important to us.”
Additionally, the appeal of value-based care over volume-based care attracted Highmark to this venture, according to Reese. In other words, Highmark was looking for the opportunity to move into more value-based models, the organization is currently utilizing a risk-based model.
Round peg, square hole
Despite the hospital-at-home model making major inroads, some major roadblocks to widespread implementation still exist.
Reimbursement barriers loom largest on this list of roadblocks, as there is no mechanism in fee-for-service Medicare to pay for the hospital-at-home model.
In the case of Contessa, Medicare Advantage (MA) has become one answer to reimbursement barriers in fee-for-service Medicare.
“We focused pretty extensively on the Medicare Advantage health plans because we knew that they had the decision as to whether or not we are reimbursed for a program,” Travis Messina, co-founder and CEO of Contessa, said at the HHCN Summit in September. “If you pick markets where there is high density in relation to MA enrollment, you could treat a credible number of patients, which could support a scalable model.”
Aside from reimbursement challenges, the general culture of health care presents a major roadblock, according to Leff.
“Hospital-at-home is still a bit of a round peg trying to get into a square hole,” he said. “A lot of health systems want to do things differently, but they don’t know how to do it. This is because things get hardwired in systems, bureaucracies are created, people get protective over their jobs, and it becomes difficult.”
But hospital at home’s sudden upward swing in 2019 is unmistakable. Joining the ranks of Contessa this year was Denver-based DispatchHealth, which launched its own hospital-at-home program as part of the startup’s continued evolution.
Founded in 2013, DispatchHealth works alongside in-home nursing care providers, offering mobile high-acuity services and urgent care in 18 markets across the U.S. In December, the company launched a hospital-at-home program to offer advanced care in the home for patients in the Denver market.
“Over the years we’ve looked at opportunities to be able to provide even more value for our payer partners, provider partners and patients,” Kevin Riddleberger, co-founder and chief strategy officer at DispatchHealth, told HHCN. “We saw an opportunity where, if we wrapped more advanced level of care around these patients, we could continue to treat them in the home, versus having to send them to the emergency department and ultimately admitted to the hospital.”
DispatchHealth’s hospital-at-home program is still relatively new, but expansion plans are already being discussed, according to Riddleberger.
“In the grand scheme of things the hospital-at-home market is small,” Riddleberger told HHCN. “No one has been able to scale it and that’s where we have a tremendous opportunity, having 18 markets across the country. I’m very bullish, moving forward.”