As hospital leaders continue to adjust care delivery models to provide the right care at the right time across their patient population, many are looking toward the hospital-at-home model as a promising approach.
Hospital-at-home programs, which allow patients to receive acute care in their homes rather than in a hospital, have been shown to boost patient satisfaction, improve outcomes, and reduce costs. To learn more about this care model, we sat down with Cynthia Vunovich, MSM, BSN, RN, and Vice President of Clinical Integration & Performance Improvement at Allegheny Health Network Healthcare @ Home.
Why did your organization decide to invest in a hospital-at-home program?
Our enterprise is really focused on healing at home, which is where most people would like to recover, and our hospital-at-home program is an extension of that value. Our program often treats patients who are experiencing an exacerbation of a chronic illness such as heart failure, COPD, or pneumonia. Or they might have a condition such as sepsis or cellulitis that requires an IV to help stabilize.
With access to more advanced technology and increasing reimbursement benefits, we’ve been able to offer home care for patients with more severe illnesses in a way that supports our enterprise initiatives around helping patients heal better.
Could you talk a little bit more about your current care model for hospital-at-home?
Typically a patient presents to the emergency department at the hospital with some kind of change in their health status. If they have a qualifying condition and meet certain insurance criteria, including inpatient admission standards, then our recovery care coordinator—or RCC—will start to work directly with physicians on the next steps of care.
If the physician determines that the patient is eligible for in-home care, the RCC performs what we call a health and home assessment survey to determine whether everything else is in place to safely admit the patient into the program. Then the RCC will work with our support teams, including our home health team, home medical equipment team, and home infusion pharmacy, to get the right staff, products, and services set up to transition that patient home and begin care within two hours of their arrival.
A typical episode of acute care in the home lasts for three to five days. Nurses are usually the primary provider in the home, and they may see the patient two to three times a day depending on treatment requirements and patient status.
Our hospitalist team oversees patients on a daily basis using virtual rounding technology. They can make medication changes and add treatments during the virtual visits, and do hemodynamic monitoring during and following the acute care stage in the model. Depending on the patient’s status, they might be referred into a traditional home care episode or into outpatient care. Our metric is to try to get them back to their PCP within seven days, and we’ve been very successful with that piece of it.
What are the main benefits of this model?
For patients, being able to recover at home is generally a huge satisfier, but it’s not for everyone. Some people aren’t comfortable with this level of activity in their homes. But for the most part, our patients have been exceedingly satisfied and happy with the care they’ve received and the ability to stay at home.
There are lots of benefits all around, not just for the patient but also for providers and hospitals. Clinicians appreciate being able to spend more dedicated time with patients, and our program helps open up additional hospital bed capacity, which was especially important during COVID-19. There is also a cost savings when you manage the patient appropriately outside of the hospital stay, and our rehospitalization rate is low.
Ultimately there are patient, provider, clinical, and financial benefits, all of which drive toward the quadruple aim.
What are some of the key challenges you encounter?
Overall, it’s really important to have the right staff, communication, and technology in place. In terms of adoption, providers need to be able to demonstrate that all the supports are there to allow the patient to safely receive in-home care. And if something is going on with the patient during their episode of care, you need to have that open line of communication with your provider so that they can quickly intervene to tweak medications, order lab work, increase an infusion, or revise the treatment plan.
How do you receive payment in this model? It sounds like with the CMS waiver, you’re able to accept more Medicare patients. Is there anything else you’d like to add?
There are multiple methods for reimbursement. Our model is a partnership between our payer provider and an external capability partner that follows a value-based reimbursement structure. This allows for shared savings across our partnership. And while the Medicare waiver allows us to take patients who are in the hospital and bring them home, the actual backend reimbursement is pretty complex between all of the partners involved.
If an organization is interested in implementing a hospital-at-home program, where would you recommend that they start?
The first piece is to understand your system, including its strategy, vision, and appetite for acceptance of a hospital-at-home program. You would need to have open dialogue with leadership to determine how people feel about it because that’s going to be key in terms of standing up the program.
Once that assessment piece is done, it’s a matter of researching the programs that are successful in the market to decide whether you want to partner with an existing organization or build the program internally. Both are viable models.
How MedBridge Helps
Whether your agency is partnering with a hospital or health system to build a hospital-at-home model, or simply taking care of more acute patients in the home, MedBridge can help you ensure that your employees have the skills and expertise they need.
To enhance operational excellence, clinical expertise, and the patient experience, home health agencies are partnering with MedBridge to deploy powerful patient education and clinician training while integrating patient management and engagement tools like virtual visits, clinician messaging, and gamification into care plans.
We offer education and training on:
- Patient-centered care
- Chronic condition management
- Interpersonal skills
- Fall prevention
- Performing common transfers
- Wound care and management
- Medication reconciliation
- Pain management
If you’d like to learn more, talk with one of our representatives today.