TEN TRANSFORMATIVE TRENDS 2021
Moving Hospital Care Into the Home: A Pandemic-Fueled Surge
Industry leaders had already been increasingly recognizing the value of hospital-at-home programs. Then the COVID-19 pandemic happened By Rajiv Leventhal
H
ome-based hospital care evolved in a big way in 2020 as hospital and health system leaders saw the opportunity to send patients home with the right tools to care for them, when possible, while also preserving critical resources and protecting the vulnerable during the COVID-19 pandemic. Historically, there have been different variations of the hospital-at-home model going back to the mid-1990s, and while programs have ramped up in recent years, the crisis has caused interest to skyrocket. Although it’s not for everyone or every condition, patient care leaders are increasingly seeing hospital-at-home programs as one viable solution to bending healthcare’s unsustainable cost curve: one study published last year in the Annals of Internal Medicine reviewed 43 hospital- at-home patients and 48 patients receiv- ing traditional hospital care, finding that hospital-at-home care was 38 percent less costly than traditional hospital care. The researchers found that only 7 percent of
was whether or not they’d try to care for COVID-19 patients—in addition to those with other conditions—at home. During a recent virtual panel discussion on mov- ing care delivery into the home, presented by Healthcare Innovation, Levine said his organization opted against it since there were lots of PPE supply issues in Boston early on in the pandemic, which would have made it tough to appropriately care for COVID patients in their homes. But by providing care for patients with infections, heart failure exacerbations, and many other conditions, Brigham was still able to create a lot of capacity for the hospital during the pandemic. In fact, Levine says the acute hospital care at home has grown into a full-service line at Brigham. Other organizations, however, have decided to care for COVID patients in the home. During a Midwest surge last fall, leaders at the Sioux Falls, S.D.-based Avera Health ramped up the health system’s existing Avera@Home Care Transitions initiative to meet the needs of
“If home hospital were a pill, everyone would pay for it. Every single payer would pay for a cardiology pill if it meant that patients would get readmitted 70 percent less often.” —David Levine, M.D.
hospital-at-home patients were readmitted within 30-days, compared to 23 percent of patients receiving traditional hospital care. That study was led by Brigham
and Women’s Hospital and Partners HealthCare System in Boston, a city where David Levine, M.D., is the medi- cal director of strategy and innovation for Brigham Health Home Hospital. As the pandemic began to unfold last spring, one of the key decisions hospital- at-home program executives had to make
COVID patients who are at least moder- ately ill, and/or have multiple or some comorbidities that make them likely to get sicker as the illness progresses, says Rhonda Wiering, vice president, clinical growth and innovation for Avera@Home. Specifically, patients who test positive, have COVID-19 symptoms, and are at high risk can be referred to the health system’s Care Transitions program by their physician. These patients receive regular phone or video nurse calls and
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telehealth equipment. Avera@Home also delivers an at-home monitoring kit to the patient’s house. The kit allows the patient to monitor their oxygen levels, blood pres- sure, temperature and COVID symptoms, with all data transmitted instantly to the care team, according to health system officials. At Avera, experienced nurses are sup- ported by internal medicine physicians, and this team is providing virtual care all day, every day for COVID patients, usu- ally for the first seven to 10 days of their illness, or until they get over the worst part of it. During one day in the middle of the region’s surge, Care Transitions was caring for 1,142 patients at home, 159 of whom were on oxygen. “In most cases, these 159 patients would have been hos- pitalized. Among these moderately and severely ill patients, we are seeing success in keeping them out of the hospital, yet we are also monitoring them in order to get them hospital care at the right time, when intervention is needed,” Wiering notes. In Danville, Pa., Geisinger started its at-home care journey more than a decade ago, focusing specifically on heart failure management, so it had the infrastructure in place to shift its model for COVID-positive patients. The first thing it did was embed a nurse case manager with a very strong clinical background in emergency room care, Joann Sciandra, vice president of care coordination and integration at Geisinger, explained during the Healthcare Innovation virtual panel discussion. That nurse works very closely with the health system’s ER physicians, and as patients come in with COVID, if they are stable enough, they are
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