The Acute Hospital Care At Home initiative from the U.S. Centers for Medicare & Medicaid Services (CMS) now has at least 80 participants, Administrator Seema Verma announced Wednesday.
Unveiled in November, the initiative has been growing rapidly, especially of late. On its end, CMS hopes the emerging hospital-at-home models can increase acute care capacity and keep patients where they’re most comfortable.
Allegheny Health Network (AHN) was the eighth organization to have its hospital-at-home program approved by CMS. It was given the go-ahead under an expedited process due to its experience with the model prior to the government initiative.
Pittsburgh, Pennsylvania-based Highmark Health is the parent company of AHN. Its businesses include a hospital and physician network plus home- and community-based services, as well as the Highmark Health Plan.
AHN’s “Home Recovery Care” program is facilitated by a joint venture with Nashville, Tennessee-based Contessa Health, a home-based care startup that has cut its teeth shifting hospital-level care into the home.
Now that its program is certified through CMS, it can be offered to Medicare beneficiaries in the regions that AHN serves.
“We’ve been looking at ways that we could provide high-quality, effective clinical care — in other places beyond the hospital — way ahead of the pandemic,” Christina Weir Ripley, VP of clinical transformation at Highmark Health, told Home Health Care News. “And as we were going through that evaluation process and looking for ways to get there, that’s when we landed on our JV partner, Contessa.”
Contessa was a logical match. It had worked with other hospital-at-home models before, including Mount Sinai Health System’s, which was one of the earliest in the U.S.
AHN began offering its program to Medicare Advantage beneficiaries in January 2020.
For AHN, patients can be admitted into the Home Care Recovery program in multiple ways. They can be admitted after an emergency room visit or in-patient visit, as well as upon observation in the hospital — or without going to the hospital at all.
The organization had already treated dozens of patients in the program before it applied for a waiver from CMS. That led AHN to believe that the transition to the Acute Hospital Care at Home Initiative would be seamless.
AHN also had a natural advantage: It owns and operates its own in-house home care services, which play a key role in the hospital-at-home concept.
“As far as the home health agency piece of it, we certainly had an advantage here as an enterprise, because we own and operate a number of different home care businesses,” Weir Ripley said. “So we were able to utilize a pretty strong and structurally organized home health network to assemble and deliver the care.”
Before the newly launched CMS program, a major barrier to hospital-at-home models was reimbursement. Reimbursement will likely continue to be a challenge moving forward, considering CMS has only made its new waiver available during the public health emergency.
“I think probably our biggest hope is that through the CMS waiver, there’s a demonstration of the value of this type of program,” Weir Ripley said. “We clearly believe in it. We implemented this ahead of the pandemic. We’re hopeful that CMS is going to codify a more permanent reimbursement path so we can continue to offer this once we get past the public health emergency.”
There were just 56 hospitals approved by CMS as of Jan. 4.
Working with patients at home
AHN’s capabilities within the home are extensive, Dr. Harshit Seth, the medical director of the Home Recovery Care model, told HHCN.
When AHN does treat patients within the home, it most often deals with COPD, pneumonia, asthma, acute renal failure and other conditions. Recently, that list also includes COVID-19.
Currently, AHN is working on treating COVID-19 patients with more advanced therapy treatments and expanding its overall offerings.
“With the program, we can decompress our hospitals, which have censuses that are blowing up,” Seth said. “I’m glad that we did this because of the pandemic, and because we can take some of these patients and keep them away from the infection. But the other reason why we started this was because the overall patient satisfaction and overall quality of care has been shown to be better — and the complications happen less.”
U.S. hospital beds were over 70% filled as of Jan. 13, with nearly 18% of them occupied by a COVID-19 patient, according to data from the U.S. Department of Health and Human Services (HHS).
The preliminary results of AHN’s program from a patient-satisfaction perspective have been good, one of the most promising aspects thus far, Seth noted.
“Everybody loves when they can be at home and get the care there, and we also have quality protocols and escalation protocols in case of an unforeseen event,” Seth said. “There’s no visitations in the hospital, which patients don’t like. So there’s a lot of mental health problems happening in patients, especially our older patients.”
Alternatively, at home, loved ones can even help with the recovery process.
In Pennsylvania, over 75% of in-patient beds were filled as of Jan. 13, with over 20% of those filled by COVID-19 patients. Nearly 80% of all ICU beds were also occupied, according to the HHS data.
As hospital-at-home models become more popular and more beneficial to both patients and health care organizations, those that have recognized the perks of home-based care prior to the COVID-19 crisis may have the upper hand.
“This is, for us, the beginning of starting to extend the type of care that we can provide in the home,” Weir Ripley said.