HOSPITAL-AT-HOME

In the US, the costs of a shift towards care-at-home service has attracted the interest of policy makers. The Centers for Medicare & Medicaid Services – in charge of the reimbursement of clinical procedures and products in the US – introduced the Acute Hospital Care At Home program in November 2020 to give hospitals more freedom while caring for patients at home, even more in the context of the COVID-19 Pandemic. In April 2023, The White house issued an executive order on increasing access to High-Quality Care and Supporting caregivers, recognizing the need to better evaluate and set expectations for family caregivers in the Acute Hospital Care at Home program.

A wide diversity of digital health technologies are currently used or envisioned to support the shift from acute inpatient care to care-at-home which gives opportunities for start-ups. Keeping into account that a substantial amount of patients enrolled in care-at-home initiatives are over the age of 65 and have limited technology literacy, it is critical to hospitals like Mass General Brigham to develop technological platforms that brake down the barriers to patients using individual technologies (e.g. dedicated tablet, technologies for patients with visual or hearing impairments). A strong interest is observed for wearable sensors that provide continuous hospital-level monitoring of patients’ vital signs, such as a chest patch that records the heart’s activity or actigraphy and accelerometer sensors that monitor patient movements. It is expected that sensor technologies will allow physicians to measure even more advanced parameters in the future, in a fully touchless manner. Artificial intelligence is foreseen to address massive amounts of data generated from sensors. Hospitals hope that AI technologies will be able to predict with accuracy the course of a patient’s disease based on physiologic measurements.  

Investments to date have been significant in the US. Typical investors are healthcare providers such as hospitals and clinics. According to recent surveys, up to USD 265 billion worth of care services for US Medicare beneficiaries could shift to the home setting by 2025. Together, Kaiser Permanente and the Mayo Clinic invested USD 100 million in Medically Home. Mass General Brigham expects its home-hospital expansion to result in annualized savings of USD 1.3 million as part of its performance-improvement plan. Some hospitals, such as Mass General Brigham expect an upcoming digit growth of hospital-at-home services to replace inpatient services in the future. They also foresee such shift to rapidly growth by 2 to 3 times in the coming 6-9 months, and within the next 10 to 15 years, 15% to 30% of inpatient care may be provided from home.

Corporate: Several programs have been initiated by US hospitals and demonstrated results:

University of Utah Health’s Huntsman Cancer Institute offers the Huntsman at Home service (2018) to oncology patients, enabling them to leave the hospital sooner or avoid going in altogether. In a study of the impact of the model, Huntsman at Home patients were 58% less likely to be admitted for an unplanned hospital stay, and those who were admitted to the hospital had a shorter length of stay. Huntsman at Home patients had 48% fewer Emergency Departments (ED) visits.

Mount Sinai’s at Home program provides hospital services and rehabilitation services to acutely ill patients who would otherwise require hospitalization. Patients who receive hospital-at-home care have fewer complications, fewer 30-day ED visits, lower 30-day hospital readmission rates, and decreased length of stay. Mount Sinai also reported increased patient satisfaction and lower cost of care. To enable private insurance companies to pay for hospital-at-home, Sinai formed a joint venture with Contessa Health to facilitate the development of contracts with health plans and other payers.

In regards to academic research, it is currently performed in the US to demonstrate and enhance the value proposition that home care has to offer patients and the entire U.S. health care system. Several institutes and organizations are dedicated to deliver research outcomes in the segment:

The Research Institute for Home Care is a non-profit, national consortium of home care providers and organizations. The Institute invests in research and education about home health care and its ability to deliver quality, cost-effective, patient-centred care across the care continuum.

The Agency for Healthcare Research and Quality, part of the US Department of health and Human Services, regularly publishes evidence reports on home-based primary care interventions, complementing research in the acute space.

University of Pennsylvania’s Institute of health economics also investigates the shift delivery of acute hospital care into the home

The American Hospital Association publishes data on the design, outcomes and objectives of care-at-home studies performed by US hospitals.