The past few years have been a time of transformation for the hospital-at-home model. As it cements its popularity, new players have begun to rise with it.

While hospital at home has long been embraced across the globe — in Australia, Canada and across Europe, for example — the model popped up in the U.S. in the 1990s. That’s when Dr. Bruce Leff conducted a successful pilot trial.

Those trials found the total cost of care was 32% lower than brick-and-mortar hospital care. They also found that the mean length of stay of hospital-at-home programs was one-third shorter.

Home Health Care News explores the model further and profiles a few of the key emerging players in this HHCN+ exclusive report.

The case for hospital at home

Over the years, robust evidence has emerged from numerous studies on the effectiveness of the hospital-at-home model – on cost efficiency, medical outcomes and more.

A 2018 study conducted by researchers at the Icahn School of Medicine at Mount Sinai found that hospital at home achieved shorter average lengths of stay compared to traditional in-patient care, at 3.2 days compared to 5.5 days, respectively.

The same study also found that the model significantly lowered rates of hospital readmissions and emergency department visits.

In 2020, another study published in the Annals of Internal Medicine found that the costs for patients receiving hospital-level care in the home were 38% lower. Researchers also found that these patients were less sedentary and had lower readmission rates within 30 days.

The hospital-at-home model has also shown promising results in the area of cancer care.

Traditionally, cancer care delivery takes place in brick-and-mortar facilities exclusively. This is also slowly beginning to change.

A 2021 study published in the Journal of Clinical Oncology found that an in-home cancer care model led to a 55% reduction in unplanned hospitalizations, with 47% lower costs.

Hospital-at-home roadblocks

Despite the evidence of hospital at home’s effectiveness, two major roadblocks have impeded the model’s widespread adoption.

One of these roadblocks is the cultural norms of health care in the U.S., and hospitals and health systems acting as gatekeepers resistant to change.

“It’s sort of the difference between understanding you need to change, knowing how to change and making the change, because some things are just so hardwired into systems,” Leff previously told HHCN. “Rewiring health care, health care delivery and attitudes — all of that is hard.”

In addition to being a pioneer in the U.S. hospital-at-home space, Leff is a geriatrician, a professor of medicine and director of the Center for transformative geriatric research at Johns Hopkins University School of Medicine.

The other major barrier is the lack of a clear path to reimbursement. This is especially notable because, for potential hospital-at-home operators, setting up shop can be a costly and time-consuming endeavor when an organization doesn’t have the right resources or infrastructure in place, according to a recent report by Chilmark, a Boston-based health care research firm.

The path to reimbursement began to open up in 2020. At the time, the U.S. Centers for Medicare & Medicaid Services (CMS) announced its Acute Hospital Care At Home program.

The CMS waiver program was a COVID-19 relief measure that allowed operators to receive payment for delivering care in the home when hospital capacity was stretched extremely thin.

The waiver has been a major game changer.

Currently, there are at least 125 health systems and 290 hospitals across 37 states approved to work under the CMS waiver. This doesn’t include the many operators that are providing care outside of the CMS waiver, of course.

Over the years, operators such as Contessa Health, DispatchHealth and Mount Sinai have positioned themselves as stalwarts in the hospital-at-home movement.

Still, the CMS waiver program was never meant to be permanent, which means that reimbursement could again become uncertain in the future.

In May, the public health emergency officially came to an end, taking with it many of the flexibilities that kept providers afloat during the height of the pandemic. However, the Acute Hospital Care At Home waiver has been extended until 2024.

Aside from cultural and reimbursement barriers, there are other challenges as well.

For one, providers need to have a consistent amount of patients admitted at any given time for their programs to remain sustainable.

Plus, internet and cellular connectivity remains an issue in some remote areas, the Chilmark report noted.

It’s sort of the difference between understanding you need to change, knowing how to change and making the change, because some things are just so hardwired into systems.

Dr. Bruce Leff of Johns Hopkins

The market’s big players

In recent years, companies that have been able to help partners implement or improve their hospital-at-home programs have become beneficiaries of the movement.

One of these companies is Inbound Health — an enablement platform that helps health systems and health plans develop high-acuity at-home care programs, including hospital at home.

“We bring all of the enablement capabilities that health systems need to launch and scale these programs,” Inbound Health CEO Dave Kerwar told HHCN. “That’s the care model, which we’ve now scaled to 6,000 different patients across 350 disease states. It’s a custom developed technology, an analytics platform. A proprietary platform we built specifically for the hospital-at-home and SNF-at-home care models.”

Originally under the Allina Health umbrella, Inbound Health spun off and became a separate entity last year.

For Inbound Health, being a high-acuity care enabler also means bringing supply chain, labor and logistics partners – as well as a machine learning analytics platform and an operations unit – to the table.

The company also helps its partners navigate reimbursement.

“We’ve created contracts with commercial and Medicare Advantage payers, and we have a replicable process we go through to be able to ensure that our health system customers get on contract so that they can be reimbursed for hospital-at-home care episodes,” Kerwar said.

When Inbound Health got started, the company had an average daily census of between five to 10 patients.

“We’ve quintupled that over the last three years,” Kerwar said. “Our average daily census is in the low 50s. We achieved this by creating a care model that was very deeply integrated into the clinical and operating workflow of the health systems we serve.”

More recently, Inbound Health expanded its services to include post-surgical care for general surgery, including orthopedics, bariatrics and hernia. This was a move to address hospitals and health systems’ capacity constraints.

In Kerwar’s view, the biggest question that remains is what the future of reimbursement looks like.

“We fully expect, given the excitement regulators have about this care model, that this will become a permanent payment model under the CMS benefit structure,” he said. “What we don’t know is exactly what it will look like, in terms of rates and requirements.”

Hospital-at-home unicorns

Biofourmis made waves when it surpassed what’s known in the startup world as unicorn status — a valuation at over $1 billion — last year when it raised a $300 million funding round.

The recent evolution of the company has been drastic, according to Kuldeep Singh Rajput, the CEO and founder of Biofourmis.

“We have truly evolved the company into a technology-enabled care delivery company,” he told HHCN. “Our focus is around how we deliver virtual care using a command center. How do we coordinate and deliver enhanced services — phlebotomy, DEM, infusion — all delivered into the patient’s home?”

Biofourmis was founded in Singapore back in 2015. The company’s U.S. offices are headquartered out of Boston.

As a company, Biofourmis has two main verticals. There’s Biofourmis Care, which is focused on care delivery across the continuum — managing post-acute and complex chronic care patients. The company leverages software and data science, along with clinical care teams, to deliver care virtually in the home.

The other segment of the company is focused on the pharmaceutical sector.

In its first year as a company, Biofourmis had seven health system partnerships under its belt. Today, that count is at roughly 60.

Rajput believes that Biofourmis’ value-add is helping its partners streamline their clinical workflows and reduce the fragmentation of point-of-care solutions.

“One of the biggest pain points for health systems is that with all of these digital tools and technologies, there’s a lot of fragmentation in the marketplace,” he said. “Hospital systems are certainly frustrated because of all these point-of-care solutions. They want to work with a partner that enables configuration of different care pathways, configuration of care continuum and acuity on a single platform.”

Infrastructure is still needed

Current Health has also gained strong momentum over the years as more health systems made moves to provide hospital at home, eventually catching the eye of Best Buy (NYSE: BBY). The electronics retail giant purchased the company in 2021.

“Current Health had our best commercial year ever after the acquisition,” Current Health CEO and co-founder Chris McGhee told HHCN. “Best Buy, through Geek Squad, has an entirely unique capability in the market to cross that final mile and go across the threshold into the patient’s home and support that individual with the technology, ensuring that the nurse or the doctor isn’t becoming IT support.”

Based in Boston, Current Health offers a platform equipped with remote care management, telehealth and patient engagement tools to help health care providers conduct at-home care, including hospital-at-home care.

Currently, the company holds upwards of a quarter of the U.S. hospital market, according to McGhee. 

The extra layer of support that Best Buy and Geek Squad offer the company has helped more patients receive care under hospital-at-home programs.

Looking ahead, McGhee believes the infrastructure around hospital at home will need to continue to grow in order for the model to continue progressing. 

“We as a society have spent trillions of dollars building up the infrastructure around the hospital, ​​making it possible within the electronic health record for us to admit a patient to the hospital with one click,” he said. “That is not the case today within the hospital-at-home market. We – as enablers, technology companies, hospitals, health systems and other partners in the space – have to collectively build up that infrastructure and make it easier to enroll and manage patients in these programs.”

The post HHCN+ Report: The Booming Hospital-At-Home Market’s Big Winners appeared first on Home Health Care News.

Starting in the spring, Charlotte, North Carolina-based Atrium Health, one of the nation’s largest integrated health systems, implemented a system that allowed patients with less severe COVID-19 cases to opt into an at-home care option.

Atrium Health oversees 50 hospitals, 44 urgent care centers and 45 emergency centers spanning three states. The health system has about 14 million patient encounters annually.

“Virtual hospital programs have the potential to provide health systems with additional in-patient capacity during the COVID-19 pandemic and beyond,” Kranthi Sitammagari, a physician from the Atrium Health Hospitalist Group, wrote in the Annals of Internal Medicine study.

Patients were first tested for COVID-19 across Atrium’s network of emergency departments, primary care clinics, urgent care centers and external testing sites. Those who tested positive were given the choice of being cared for virtually at home or in the hospital, if their symptoms were severe enough.

Virtual options included Atrium’s home-based virtual observation unit (VOU) or its virtual acute care unit (VACU).

The VOU was designated for low-acuity patients who could be managed remotely with daily check-ins from RNs. The VACU was for patients with mild-to-moderate symptoms who would otherwise be sick enough to be admitted to the hospital.

VACU patients were set up with a hospital bed, medical equipment and videoconferencing tools within 24 hours. Additional follow-up services included oxygen assistance, medical treatments, daily virtual physician rounds, vital-sign monitoring, twice-daily nursing assessments and more.

Nearly every single patient who tested positive picked Atrium’s hospital-at-home option when given the choice, Stephanie Murphy, the medical director of the program, told Medscape Medical News. 

From March 23 to May 7, Atrium treated 1,477 patients at home after receiving a COVID-19 diagnosis. That accounted for 64% of all of its COVID-19 patients from that time period.

On average, the 1,477 patients “stayed” in the hospital-at-home settings — the VOU, VACU or both — for 11 days. Of the 1,293 patients that received care in the VOU only, just 3% required in-patient hospitalization.

Patients admitted to the VACU most often received supplemental oxygen or a respiratory inhaler. Other resources provided from Atrium were intravenous fluids and antibiotics, when appropriate.

Even when a patient’s symptoms increased to a point where their care plan needed to be intensified, patients mostly elected to keep receiving that care at home. A part of the reason for that, Murphy told Medscape Medical News, was because they wanted their loved ones to be able to visit them.

Hospital-at-home models have become increasingly popular. A slew of health care organizations, including DispatchHealth, BayCare and Lifesprk, have either launched hospital-at-home programs on their own or facilitated them in the last year.

Programs will likely continue to pop up moving forward, too, as recent COVID-19 surges across the country have put hospitals back into crisis mode.

In the week spanning from Nov. 4 to Nov. 11, nearly 20% of American hospitals dealt with staffing shortages. That number increased this week, according to data provided to The Atlantic by the U.S. Department of Health and Human Services (HHS).

The post Atrium Health Boosts Capacity with Virtual Hospital-at-Home Model appeared first on Home Health Care News.

That revelation likely isn’t a shock to home health care providers that deal with getting physicians to sign off on care plans. Communication and care coordination are well-known struggles for both sides.

While physicians are required to certify a plan of care for patients who receive Medicare skilled home health care services, the amount of time they actually spend reviewing the paperwork reveals that the current communication streams are lacking quality.

“Our data suggest that the significant majority of physicians spend little time reviewing the plan of care developed by the home health agencies,” Bruce Leff, director of The Center for Transformative Geriatric Research and a professor of medicine at Johns Hopkins, told Home Health Care News.

Part of the problem with the communication is simply the format that the plan of care typically takes. The form, commonly known as the CMS-485, is “not useful or conducive to communicating useful information that could be better used to foster care coordination and care planning,” according to Leff.

Of more than 1,000 respondents in the study, 72% of participants—which included physicians specializing in family or general medicine, geriatrics, geriatric psychiatry, internal medicine, or hospice and palliative medicine—had certified at least one plan of care in the past year.

Nearly half, 47%, said they spent less than one minute reviewing the CMS-485 form before certification; 21% said they spent at least two minutes reviewing the form before certification.

However, most home health care agencies stick with the format because it isn’t likely to lead them astray in terms of an audit later on.

“It’s only a suggestion from CMS, but most agencies use that format because they know that it is a completely safe format to use from a regulatory standpoint,” Leff said.

Once the plan of care is certified, it is also rarely changed. About 80% of respondents said they rarely or never changed an order on the CMS-485, and 78.3% rarely or never contacted the home health care clinicians with questions.

After finding just how little time physicians spend on care plans and communicating with home health care agencies, researchers are planning to look at the issue from the perspective of home health care providers, with a grant from the Alliance for Home Health Quality & Innovation.

“A key thing in the home health care space is to figure out how to [improve] communication, with the majority being agencies that are not integrated with primary care,” Cynthia Boyd, professor at the Johns Hopkins Bloomberg School of Public Health and lead research author, told HHCN. “Addressing it is really important.”

Written by Amy Baxter

The post Johns Hopkins: Most Doctors Spend One Minute Reviewing Home Health Plans appeared first on Home Health Care News.