The hospital-at-home program is an innovative model that enables health care organizations to provide ill patients with quality hospital-level care at home. The program has been adopted by various health care providers, including home health care agencies, and has demonstrated that it reduces costs, improves outcomes, and enhances the patient experience.
How the Hospital-at-Home Model Works
The structure and implementation of hospital-at-home programs vary depending on the hospital’s needs and capacity and the patient population. Some hospitals run the program out of the emergency department (ED) and admit eligible patients to their homes, while others rely on referrals from the community, paramedics, or specialty clinics.
The model is designed to serve medium-acuity patients who require hospital-level care but are stable enough to be monitored safely from their homes. These include patients with pneumonia, congestive heart failure, chronic obstructive pulmonary disease (COPD), diabetes, or cellulitis.
After being evaluated at the ED, clinic, or ambulatory site and determined to be a good candidate for a hospital-at-home program, patients are transported to their homes, typically by ambulance. The patient is given extensive nursing care at home, followed by at least daily nursing visits based on clinical need. Patients are consistently connected to their care team through in-person physician visits, video visits, and continuous biometric monitoring via telehealth technologies. Nurses are available 24 hours a day, seven days a week, in case of an emergency.
At the patient’s home, diagnostic studies such as electrocardiograms, echocardiograms, and X-rays can be performed, as well as treatments such as oxygen therapy, intravenous fluids, intravenous antibiotics, other medicines, respiratory therapy, pharmacy services, and skilled nursing services. Short hospital visits are available for diagnostic and therapeutic procedures that cannot be performed at home, such as computed tomography, magnetic resonance imaging, or endoscopy.
For the model to work effectively, home health care providers must also ensure that a patient’s home is conducive to hospital-at-home care, with adequate internet access, air conditioning, heat and running water, and social support.
The patient is cared for until he or she can be “discharged.” When the hospital-at-home physician discharges the patient, responsibility for care is returned to the patient’s primary care physician.
Better Outcomes, Reduced Costs
According to a brief by the American Hospital Association (AHA), a meta-analysis of 61 studies found that patients who received hospital-at-home care had a 20% lower mortality rate. At the same time, another randomized control trial discovered that acutely ill patients admitted to hospital-at-home care through the ED were three times less likely than usual-care patients to be admitted to a traditional hospital within 30 days.
Furthermore, providing hospital-level care at the patient’s home is a less expensive care setting than the hospital. The hospital-at-home model has a 25% lower cost of stay on average.
Payment is one of the barriers to the utilization of the hospital-at-home model. According to the AHA, most private payers do not cover hospital-level care in the home setting. The Veterans Affairs network, essentially a single-payer system for its population, is one example of a hospital that has successfully navigated the payment challenge. Hospital-at-home care is also covered by health systems that have their own insurance plans. To increase health care capacity during the pandemic, the Centers for Medicare & Medicaid Services (CMS) in November 2020 launched the Acute Hospital Care at Home waiver program, which allows hospitals to treat beneficiaries in their homes.
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