BayCare — a large, Florida-based nonprofit health system — is the latest organization to join the ranks of those offering hospital-level care in the home setting.
The health system recently announced it will provide access to acute-level care in the home to help care for patients battling COVID-19, heart failure and COPD, among other possible conditions. BayCare is launching the hospital-at-home program through its home-based care arm, BayCare HomeCare.
The new program will operate as a hybrid model, combining the company’s home health service lines, remote patient monitoring, virtual visits and in-person visits, according to BayCare Vice President Dr. Jacquelyn B. Cawley, who also serves as CMO for ambulatory care and clinical integration.
“The nurse will actually go into the home and do a combination of face-to-face visits, as well as virtual visits,” Cawley told Home Health Care News. “With the remote patient monitoring, we’ll be able to monitor vital signs, … the nurse there in the home will also help host that virtual visit with a provider while being the eyes and ears.”
As one of the largest health care systems in Florida, BayCare operates 15 hospitals that serve four counties. BayCare HomeCare serves roughly 6,000 patients daily and covers 13 counties.
Through the hospital-at-home program, BayCare will also administer IV therapy, IV medications, IV hydration and other services.
As an organization, BayCare had its sights set on entering the hospital-at-home space for a while.
Still, the ball didn’t get rolling until the impact of the COVID-19 public health emergency hit, according to Cawley.
“We were very hard hit in Florida, and we wanted to help to decompress the hospital and our emergency departments,” she said. “In our home care, we were taking COVID-positive patients from the emergency departments, as a way to help mitigate the numbers of patients that they had. We were also taking early discharges from the hospital into either a hotel, an alternate care site or into their home setting.”
After tackling COVID-19 patients, providing hospital-level care at home on a permanent basis seemed like a natural progression for BayCare.
“We could bring pretty much everything that they would get in a hospital to the home setting for those appropriate patients safely,” Cawley said. “We were able to prove that with our COVID-positive patients, and we’ll be moving forward with that population, especially now that we’re starting to see the numbers increase again.”
As the end of the year approaches paired with a normal flu cycle, many health care providers are gearing up for an influx of new coronavirus patients.
While the model has gained a reputation for providing better outcomes at a lower cost, hospital-at-home has still mostly existed as a niche service line for providers in the U.S.
This was until 2019, when it seemed that the hospital-at-home model began to gain ground. A number of providers across the country implemented programs, including Highmark Health, CommonSpirit and Prisma Health.
For many providers, the prospect of launching a new hospital-at-home program can be daunting. Moving into this space requires an organization to have a strong clinical staff and operational support in place.
Being a large health system gave BayCare an advantage in this regard, according to Cawley.
“BayCare has a lot of resources and assets, as a large health system,” she said. “We had everything with home care already set up, as far as the remote patient monitoring. We have the nurse support. We already had that virtual platform, and we also had a specialty pharmacy IV therapy that was done through our nurses.”
Additionally, as a large health system, BayCare had urgent care providers and a robust on-demand virtual urgent care service.
With all of BayCare’s resources at its disposal, the key challenge was making sure everything came together coherently.
“Most of the resources we already had in place; it was just about how to coordinate them and bring them all together,” Cawley said. “We worked very closely with the hospital, with the emergency departments on what the workflow is. We have clinical criteria that we use, that we developed with our ED physicians, our hospitalist physicians and others in the community to really identify who are the best patients for this type of home-based service.”
When it comes to hospital-at-home models, reimbursement has always presented a challenge for providers looking to enter the space. Lately, that has become easier to navigate, according to Cawley.
“One of the reasons we chose to go with home care-based services is because we had a methodology to bill through home care appropriately, as long as we had a provider order and the patient was eligible for it,” she said. “We had a mechanism to bill for physician visits virtually once COVID came about. So there’s been more opportunity in 2020, between Medicare allowing for remote patient monitoring, and then more recently with COVID, for all of our payers to actually support virtual visits.”
Cawley believes the COVID-19 emergency has had a significant impact on the hospital-at-home model. Anecdotally, the interest in implementing similar programs continues to grow.
“When we talk to our counterparts across the country, everyone is either doing, planning or piloting something along the lines of this,” she said. “As long as we have the continued support of Medicare and other payers to support virtual care, I think we’ll be able to continue to move to this.”