Health Care System Can’t Afford to Make Blockbuster’s ‘Netflix Mistake’ with In-Home Care

The federal government and other private stakeholders play an important role in addressing the unique challenges of accelerating hospital-at-home delivery.

That’s according to a group of health care experts who spoke on the future of hospital-at-home models during a Friday webinar hosted by the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

“Medicare has a central role to play. … We want to advance health equity, expand access to care, drive high-quality, person-centered care, and promote affordability and sustainability,” Dr. Meena Seshamani, deputy administrator and director at the U.S. Centers for Medicare & Medicaid Services (CMS), said during the webinar.

Certainly, one major example of this is CMS’s “Acute Hospital Care at Home” program, which gives eligible health systems and hospitals the ability to provide acute-level care to certain patients in their homes.

After years of making small inroads, CMS’s wavier pushed the hospital-at-home model forward in a major way. As of Nov. 8, 83 health systems and 187 hospitals across 34 states had been accepted as participants in the waiver program.

To continue moving forward, though, public-private partnerships will be important.

“As we take care upstream and start thinking more holistically about what people need, that requires bringing together various pieces,” Seshamani said.

Seshamani noted these types of partnerships have already begun to form between CMS and external partners. In fact, these partnerships were critical in the development and execution of the Acute Hospital Care at Home program.

“There was considerable private-sector work that went into that. And looking forward, where are the opportunities to help connect the various sectors that play a role in care?” she said. “[I’m] thinking about the public health workforce, for example, and the role that community health workers can play in providing more holistic care — meeting people where they’re at.”

Similarly, Dr. Reed Tuckson pointed out that the pursuit of these partnerships presents an opportunity for hospital leaders to begin conversations with the “power people” in their surrounding communities.

“Now, do you find a way for the business community … to be more invested in community robustness of the infrastructure?” Tuckson, managing director of Tuckson Health Connections, said during the webinar. “Because not only does it meet the moral equivalent of doing right by people. … There’s an enlightened self-interest here because this decreases overall health care costs.”

Indeed, hospital-at-home has gained a reputation for the model’s ability to curb costs, as well as improve health outcomes.

“There’s quite a robust literature to suggest that many patients want this kind of care and they would prefer to be at home,” Dr. Bruce Leff, a professor at the Johns Hopkins University School of Medicine, said during the webinar. “There’s a lot of evidence to suggest that there’s better patient and family and caregiver experience with getting care at home. The care is high quality by pretty much any metric you can use, … plus lower costs.”

For example, John Hopkins saw lower rates of complications in a national demonstration study the organization conducted in the early 2000s.

“We had, for instance, a 75% reduction in incident delirium, so acute confusional states, which can contribute to long-term cognitive decline in older adults,” Leff said.

Johns Hopkins has been exploring the hospital-at-home model since the early 1990s. While Johns Hopkins doesn’t currently operate a program, the organization is generally considered to be a pioneer in the space.

Hospital-at-home programs also play a role in helping patients feel more comfortable with their clinician, according to Leff.

“When you’re a clinician in someone’s home, the locus of power completely shifts,” he said. “It’s very different when I walk into a patient’s hospital room wearing a white coat, versus walking into someone’s home as a guest. The conversations are a bit more real. I think it really does add a dimension to equity that we often don’t think of.”

Looking ahead, it’s likely that health care stakeholders will have built on the hospital-at-home successes that have stemmed from the COVID-19 emergency.

“I think it’s a whole different ballgame than 20 years ago when we began to more aggressively pursue a value-based model,” Dr. Craig Samitt, founder and CEO of ITO Advisors, said during the webinar. “I think the whole world could change quite dramatically in five years. I harken back to the decision that Blockbuster made in 2000 to pass on the opportunity to buy Netflix for $50 million or less. I hope that we as health care incumbents don’t make the same mistake when thinking about care in the home.”