Kaiser Permanente, Mayo Clinic, Johns Hopkins and Others Form ‘Advanced Care at Home Coalition’

Some of the most premier health care organizations in the U.S. are coming together to form the “Advanced Care at Home Coalition.” The newly formed entity will vie for legislation that will allow more patients to receive hospital-level care in their homes moving forward.

Many of the provisions that have allowed health systems and home-based care players to treat patients in their homes during the COVID-19 crisis are tied to the public health emergency (PHE). The worry is that when the PHE expires in December, progress will be lost.

The founding members of the coalition were Medically Home, the Mayo Clinic and Kaiser Permanente, the latter two of which invested $100 million in Medically Home – a hospital-at-home enabler – earlier this year.

Additional member organizations of the coalition include Adventist Health, ChristianaCare, Geisinger Health, Integris, Johns Hopkins Medicine, Michigan Medicine, Novant Health, ProMedica, Sharp Rees-Stealy Medical Group, UNC Health and UnityPoint Health.

Johns Hopkins is widely seen as the pioneer of the original hospital-at-home model in the U.S.

“Over the course of the last year and a half, multiple systems have gotten 1,000 or more patients enrolled in these programs,” Dr. Stephen Parodi, the executive vice president of The Permanente Federation, told Home Health Care News. “We know that the waivers are tied to the PHE, whether it gets extended or not. But once that PHE expires, many of these programs are going to be facing a regulatory cliff.”

The Oakland, California-based health care giant Kaiser Permanente is both a provider and health plan. The organization – which The Permanente Federation is a part of – currently serves 12.2 million members from over 600 locations in eight states and the District of Columbia.

The health system has cared for hospital-at-home patients through the Centers for Medicare & Medicaid Services’ (CMS) “Acute Hospital Care at Home” waiver and another advanced care model over the last year and a half.

The coalition – which is similar to the Moving Health Home coalition, albeit with different home-based care goals – wants to set more permanent pathways for hospital-at-home care moving forward. Specifically, it would like to see The CMS Innovation Center test acute-care-at-home delivery models.

“We collectively think that it’s important that these programs are allowed to continue while we develop the appropriate guardrails and a measurement strategy for being able to put together a demonstration project,” Parodi said. “Then, we’d be able to show the value of these programs from a quality, safety, satisfaction, equity and also financial perspective.”

There are currently 77 health systems and 177 hospitals in 33 states approved for Acute Hospital Care at Home, according to CMS. The waiver has allowed health systems to open up space for COVID-19 patients in hospitals and also be properly reimbursed for hospital-level care at home during the pandemic.

While insiders are confident some sort of extension of the waiver will come to fruition, some health systems see problems with the waiver that need to be addressed before anything becomes official.

The coalition’s goal is to not only advocate for more hospital-level care at home, but also to point lawmakers in the right direction when developing a demonstration.

“By proving we can provide high-quality acute care outside of a hospital building, we have turned on its head the notion of where patients with serious or complex conditions can be cared for,” Michael Maniaci, the physician leader for advanced care at home at Mayo Clinic, said in a press release. “By further developing a nurturing policy landscape, we can advance the well-being of patients by catalyzing innovative, collaborative, knowledge-driven models to redefine the standard of high-acuity care that meets each person’s unique needs.”

More than anything, this has to do with the patients and the new type of care they’ve been exposed to during this unique period, Parodi said.

“We’ve seen significant uptake,” he said. “Patients are able to recover faster, and they’re able to get additional services beyond the hospitalization in a more seamless fashion, without the transition that you would have from a brick-and-mortar hospital to another venue of care.”

If patients need to transition from acute-level care to post-acute, for instance, that can all be done in the home. And it can be done without patients having to lay in a hospital bed for days while their health deteriorates, only to be moved again to another setting.

Kaiser Permanente’s patients, on average, have rated its hospital-at-home programs at 4.9 out of 5, a number “you just can’t match” elsewhere, Parodi said.

A demonstration, or a more future-facing version of the waiver, would allow for more specific measurements and baselines of success for hospital-at-home participants, the coalition believes.

It would also allow for other providers, such as home care and home health organizations, to get involved.

“I do think home-based organizations stand to benefit,” Parodi said. “Even with the existing programs, there’s sort of the advanced care part, which is the classic, hospital-level care. But then the patient progresses, and some of them get better enough that they can be discharged from the program altogether. But some patients still need additional help. They may need classic home health services or other services that, if they don’t get them, they may end up back in the hospital. … So we welcome the expertise of a classic home health agency to be able to inform on what that seamless transition looks like.”

Hospital-at-home has advanced “light years” during the pandemic, Parodi said.

Many of the involved health systems were already putting together focus groups prior to COVID-19 to start – or advance – these types of programs, but the actual experience has been invaluable.

A halt to the flexibilities that have been offered to providers during the pandemic, however, could be damaging, which is why the coalition was created now.

“This model will finally allow underserved patients safe and cost-effective access to care that is long overdue,” Rami Karjian, the CEO of Medically Home, said in the press release. “We look forward to working with Congress to expand access to this safe and effective model of care delivery.”