Medically Home’s Rakowski: The Hospital-at-Home Model Is the ‘Poster Child’ for Value-Based Care

The COVID-19 emergency has made the hospital-at-home model more relevant than ever.

Despite incredibly promising results from multiple programs, the hospital-at-home model had previously been slow to gain traction in the U.S. But now, the model’s ability to forgo the hospital setting makes it the perfect care model for this particular moment in time, many experts believe.

Among the handful of hospital-at-home operators to stand out in this space is Medically Home, a Boston-based company that brings acute-level care into the home. As part of its model, Medically Home sends clinicians into the home, along with technology, equipment, medication and supplies.


By directing those resources directly to acutely ill patients’ bedsides, Medically Home hopes it can lower overall health care spending and improve patient outcomes.

To learn more, Home Health Care News recently caught up with Raphael Rakowski, executive chairman and co-founder of Medically Home. Rakowski shared his thoughts on how COVID-19 is breaking down barriers when it comes to hospital-at-home, how the model fits into a value-based care environment and the potential impact of the 2020 presidential election.

Prior to this Q&A, Medically Home most recently made headlines for its partnership with Mayo Clinic in Jacksonville, Florida.


You can read the highlights from HHCN’s conversation with Rakowski below, edited for length and clarity.

HHCN: Can you talk about Medically Home’s growth leading up to and during COVID-19?

Rakowski: I would say that it was anemic from 2017 through 2018. In 2019, there was an enormous amount of movement. I think this was primarily driven by hospitals that were full, taking a second look at their alternatives. I think value-based programs were starting to get traction, though in a limited way.

We saw double-digit growth last year. But as soon as the data started coming out of China and Italy, as soon as the coronavirus started to hit the United States in early March, it felt like a tsunami. The triggers for market growth were initial capacity constraints, then value-based model exploration. Now, it’s COVID-19.

There are real concerns about patients going back to the hospital because of the infection risk. My view is that’s what’s really driving the market right now.

Our growth has been exploding as a result. I’m not sure if that’s the single root cause, but COVID-19 is definitely a significant propellant to what’s happening to our company right now.

In your view, what are the current barriers to the hospital-at-home model?

I think the barriers remain the same. It’s just a lack of a cohesive national strategy for payment.

I think some of the other barriers I would have pointed to six months ago don’t exist anymore. For example, understanding the relevance of the program is a barrier that is now gone. Patients’ willingness to be cared for at home — and their concerns around that — is also a barrier that’s largely gone. I think the biggest barriers to hospital-at-home programs that remain are related payment and regulatory policies.

Again, though, COVID-19 has been the most significant catalyst to date for the hospital-at-home model because of the dual needs of hospitals needing more capacity and patients’ concerns surrounding hospitals.

Let’s talk about Medically Home’s outcomes. Does the company have any success stories or metrics to share?

We are seeing a significant reduction in readmissions across our operations. We’re also seeing very high patient outcomes and patient satisfaction, relative to hospital benchmarks. We’re also seeing a meaningful reduction in costs.

Reduction in costs is the thing that has been reported most consistently when it comes to the research on hospital-at-home programs. There are the fixed costs of the hospital, which are not being used. They’re being arbitraged out, because we are using the patient’s home as the site of care.

Those costs that are no longer in play can then be used to provide more care over a longer period of time, which reliably creates higher patient satisfaction.

What does the 2020 election mean for hospital-at-home? Would a Biden administration be more willing to embrace the model? Or has the current administration already been supportive?

That’s a fantastic question — the answer is I don’t know. The current administration is very focused on going after regulatory barriers and reducing red tape. This administration came up with the hospital-without-walls waiver. I think it’s been generally supportive of the model.

The question is Biden and the potential movement toward a single-payer system. I don’t have enough insight to know structurally what’s going to happen. I do know that the cost of health care is still extraordinarily high and growing. And the impact on hospitals’ finances have been stunningly large because of the cessation of elective surgeries during the early days of the COVID-19 pandemic. There’s been a really mixed bag of financial drivers that are going to affect either administration as a result of the COVID-19 virus.

If you’re asking me to make a prediction, I would say that both administrations are going to be extraordinarily supportive of hospital-at-home moving forward, because the market drivers are larger than the political left or right on this.

How does hospital-at-home fit into a value-based care environment?

The heart of value-based care is to deliver superior outcomes at lower costs. The model was designed from the outset to do that. It’s the poster child for value-based care — it provides a better experience, the costs are lower and the outcomes are better. In terms of a value-based strategy, having a hospital-at-home program is critical.

You can’t be in a value-based strategy unless you have an alternative site of care that looks like the home.

How do non-Medicare payers currently see the hospital-at-home concept? Is this something Medicare Advantage plans and managed care organizations are interested in?

Yes, in fact we’re getting a lot of traction with them. The overall market is becoming more and more familiar with this. There’s a lot of dialogue going on between providers and payers, both in the commercial space and the MA space.

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