The concept of Hospital-at-Home (HaH), first introduced in the 1990s and not widely used, gained renewed attention and increased deployment across the United States during the pandemic. As hospitals faced overwhelming patient demand, the Centers for Medicare & Medicaid Services (CMS) introduced a temporary waiver program, reimbursing hospitals for treating acutely ill patients in their homes when they would otherwise be treated in a hospital.
Since then, over 300 hospitals have been approved to provide care through the program. Despite successes seen at leading institutions such as Mass General Brigham, Mayo Clinic, and Mount Sinai Health System, the waiver program is set to expire at the end of 2024. Proposed legislation aims to extend the flexibility, but the long-term future of HaH in the U.S. remains uncertain without a permanent solution in place.
While challenges like integration with existing healthcare systems persist, HaH programs have proven viable and beneficial worldwide. Countries like Australia, the United Kingdom, Spain, and Canada have successfully implemented these programs, demonstrating their effectiveness and reinforcing the importance for the U.S. to sustain its waiver program.
Global Perspectives on At-Home Hospital Care Programs
Australia has been at the forefront of HaH programs, with Victoria’s “Hospital in the Home” (HITH) initiative established over two decades ago. These programs have effectively treated acute conditions such as cellulitis and chronic illnesses like Chronic Obstructive Pulmonary Disease (COPD), leading to fewer hospital readmissions and high patient satisfaction rates. Additionally, the Royal Melbourne Hospital offers specialized care plans for both short-term and long-term HaH needs.
In the United Kingdom, at-home programs, known as “virtual wards“, are integrated into the National Health Service’s (NHS) healthcare strategy. Utilizing remote patient monitoring (RPM) devices and telehealth consultations, the initiative is a key component of the NHS’s plan to manage chronic diseases and provide post-operative care. Virtual wards have been particularly effective in managing heart failure, respiratory conditions, and post-surgical recovery.
Spain has established robust HaH programs, particularly in Catalonia, Barcelona, and the Basque Country. These programs rely on multidisciplinary care teams comprising doctors, nurses, and social workers to address complex patient needs. HaH programs in Spain have demonstrated significant cost savings, reduced hospital stays, and improved patient outcomes.
While Canada has a strong home and community system for chronic conditions, several hospitals in British Columbia have recently launched HaH programs offering acute-level care, along with hospitals on Vancouver Island and in northern B.C. These programs, supported by teams of doctors, nurses, pharmacists, therapists, and specialists, have successfully managed conditions like sepsis, pneumonia, and COPD at home.
Key Insights from Global HaH Approaches
The global implementation of HaH programs offers useful examples for the ongoing development and expansion of these initiatives in the U.S. and beyond. The successful approaches provide important insights, such as:
- Patient and Caregiver Engagement: Empowering patients and caregivers with education, training, and ongoing support enhances their ability to participate in HaH care. Australia’s approach to prioritizing patient education and support programs, including a webinar series, has been essential for patient understanding of care benefits. With continuous education and guidance, patients are more likely to adhere to treatment plans, leading to improved outcomes and satisfaction.
- Multidisciplinary Care Teams: Employing multidisciplinary teams, as seen in Spain and Canada, ensures comprehensive patient care by addressing physical, emotional, and social needs during HaH care. Investing in training and coordination for these teams is crucial. Partnering with digital health companies that offer clinician portals for multi-patient monitoring, along with implementing systems to share information and coordinate care across healthcare settings, ensures comprehensive HaH care.
- Investment in Digital Health Infrastructure: Integrating intuitive and user-friendly digital health technologies is a key component of at-home hospital-level care. The UK’s virtual wards demonstrate the value of robust digital infrastructure. Collaborating with RPM companies offering medical wearables for real-time continuous monitoring enhances patient care by providing alerts and notifications on critical patient information to healthcare teams as it happens.
- Government Support and Policy Frameworks: Strong governmental backing is essential. Countries like Australia and the UK have established supportive policy frameworks that encourage HaH adoption. Developing clear regulations is necessary to ensure patient safety, maintain high-quality care, and secure financial viability. Financial incentives, such as reimbursement models tailored to HaH services, encourage providers to invest in and expand these programs.
The Uncertain Future of HaH in the U.S.
The looming expiration of the HaH waiver program in the U.S. carries significant potential consequences for patients, healthcare systems, and overall healthcare costs. Patients who have benefited from HaH care could face disruptions in their treatment plans. Healthcare systems, already dealing with capacity constraints, may experience higher operational costs and reduced efficiency, resulting in longer wait times and strained resources.
While HaH programs require an initial investment in technology, staffing, and training, studies have proven they can ultimately reduce healthcare costs through shorter hospital stays and decreased readmission rates. The diverse approaches and successes of HaH programs worldwide demonstrate the value of tailoring them to different healthcare systems and patient needs. By learning from these various approaches, the U.S. can implement a long-term HaH program as a cornerstone of healthcare delivery.
About Aaron Timm
Aaron Timm is Executive Vice President and Chief Commercial Officer at Vivalink, a leading provider of digital healthcare solutions. He drives commercial strategy and development for its rapidly-expanding customer base in clinical research and healthcare. Prior to joining Vivalink, Timm was CEO of WorldCare Clinical, a global imaging clinical research organization and Timm served as CEO of Synarc, a global imaging CRO. A graduate of Georgetown University and Harvard University, Timm’s career began in law, with experience as general counsel of both private and publicly-traded companies.