‘Grow, Scale, Execute’: How Mass General Brigham Is Accelerating Its Care-At-Home Arm

Hospital at home’s presence in the U.S. continues to grow. But even before the care delivery model became more visible, Mass General Brigham was a major player in the space.

The health system first launched its hospital-at-home program way back in 2016, predating the hospital-at-home boom that followed the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver in 2020.

At Mass General Brigham, hospital at home is only the tip of the at-home care iceberg, however. The health system also offers traditional home health care, palliative care and other home-based care services.

Heather O’Sullivan, president of Mass General Brigham’s Healthcare at Home segment, joined Home Health Care News for the latest episode of HHCN+ TALKS.

The recording and transcript of the conversation with O’Sullivan are below.

Read on to learn more about:

— The variety of ways Mass General Brigham is delivering care in the home

— How Mass General Brigham serves a diverse patient population with success

— Mass General Brigham’s partnership with Best Buy (NYSE: BBY) and Current Health.

HHCN Editor Andrew Donlan: Welcome, everyone, to another edition of HHCN+TALKS. I’m Home Health Care News Editor Andrew Donlan, joined by Heather O’Sullivan, the president of Mass General Brigham Healthcare at Home. Heather, thank you so much for joining me today.

Heather O’Sullivan: Great to be here. Thank you.

HHCN: Before we get into any of the heavy topics, a little background on you.

O’Sullivan: Sure. Heather O’Sullivan, the president of Healthcare at Home. Also, an adult and geriatric nurse practitioner, and I’ve spent most of my life’s career in the post-acute space, both within payer and provider organizations. Then, prior to joining MGB, I led clinical innovation for the nation’s largest home care and hospice company, Kindred at Home, which was then acquired by Humana.

For the past two years, I’ve had the privilege of designing and leading Mass General Brigham’s inaugural division of Healthcare at Home that we’re going to talk quite a bit about today. I’m pleased to share with you more about our system, and really, most importantly, the strategic priority to home-based services as a critical imperative across the continuum of care for our enterprise.

HHCN: Okay, fantastic. I assume almost all of our audience is familiar with Kindred at Home, now CenterWell Home Health under the Humana umbrella. In terms of MGB, can you give us an overview of the system and then how Healthcare at Home fits within that?

O’Sullivan: At Mass General Brigham, our priority is becoming an integrated academic medical center of the future with patients at the center. The system is comprised of three world-class specialty hospitals, including mental health, acute rehab, serious eye and ear care, in addition to seven community hospitals, including two island locations, and then finally the two founding academic medical centers, which are Mass General Hospital and Brigham and Women’s Hospital.

All combined, Mass General Brigham is actually the largest NIH recipient in the country for research, and we’re the largest employer of all Massachusetts, with over 80,000 colleagues, serving patients both locally, as well as those who seek our expert care from across the nation and globally. At Mass General Brigham, the level of Healthcare at Home is a division that was established in 2022. A truly bold enterprise commited to true patient-centered care, ensuring consumers have hybrid alternatives to care across the continuum versus what we all think of as more traditional brick-and-mortar settings today.

We’re increasingly seeing patients and families choose home as their desired setting for convenience, comfort, and privacy. However, Healthcare at Home, our portfolio specifically, is comprised of four service offerings within the larger system. Within our Healthcare at Home portfolio, we offer Home Hospital, which is the largest full acute episode of home hospital in the country. One of the first in the nation, actually. It comprises five distinct CMS licenses for acute-level care. Again, that’s Eastern Massachusetts.

We also have a legacy traditional home health, also the largest in Massachusetts, about 1,000 FTEs with an average daily census of 4,000. The third would be palliative care at home, which is an extension of our successful enterprise brick-and-mortar palliative offering. Then, finally, we offer a new emerging pilot program of emergency care at home through our long-standing MIH, Mobile Integrated Health program, addressing both urgent and emergent patient needs, as well as fast-tracking access to some of the most appropriate services for our patients.

HHCN: Really a future-facing home-based care arm there at MGB. I’m curious, Heather, just from a personal perspective, you’re with Kindred at Home, more of a traditional home health care provider. Now you’re leading this enterprise within a larger health system. What’s been different with those roles that you’ve held in those two organizations?

O’Sullivan: Being within a much larger integrated delivery network system really empowers the acceleration and the rate of change that we’ve been able to drive from an innovative clinical design model perspective. It’s really just absolutely fantastic having the expertise across a broad array of service offerings, and certainly the funding and the strategic commitment from the top of our executive team about this being an imperative for the future.

HHCN: Okay, fantastic. Well, let’s get into it. MGB, has it always been as committed to home and community-based care? It seems like yes is the answer to that, but at the same time, efforts were very much ramped up, as you said, in 2022 when this segment was created.

O’Sullivan: Sure. The system has been focused on care at home since the establishment of what we know now, and I mentioned a little bit earlier, our legacy Mass General Brigham Home Care, it’s one of the verticals within the Healthcare Home division. I mentioned those four. The home care line of business was established actually all the way back in 2000 through a merger of 27 visiting nurse associations in the area. Our home care business provides typical traditional in-home skilled and other services that you would imagine, PT, OT, speech, social work, et cetera. We also offer a personal emergency response system, infusion care, and dedicated phlebotomy unit. It’s quite progressive and extensive.

National Brigham Home Care is one of our most strategic assets in a rapidly evolving health care ecosystem, really positioning us well to meet the needs of the community that we serve, as well as, our attributed health plan lives from a value-based care perspective. And then through our scale of home hospital, we’re able to address the system’s biggest challenge, which is really access to care with the capacity constraints that we face day in and day out. Our established Mass General Brigham Home Care business is the chassis for our growing portfolio of all health care home services.

HHCN: Do you feel like this is a strategic advantage for the health system, that it’s so committed to home-based care? A lot of health systems have either pulled away from home-based care during the pandemic because they want to focus on core services. Others have leaned in, but they’ve had to lean in without 20 years of already having a home care division. Do you feel like MGB has an advantage in that aspect?

O’Sullivan: Yes. However, every system’s “why” is a little bit different, and for the reasons that I explained, we have the health plan, we have capacity challenges, and we also, again, have that very heavy research and innovative component which makes it ideal for us to focus on defining what a playbook could be for other systems wanting to launch this type of future care.

HHCN: You mentioned the hospital-at-home program earlier and how mature that now is. I’m curious, though, how did it get started in the first place?

O’Sullivan: For context, Mass General Brigham Home Hospital was one of the first systems in the country, all the way back in 2016, to launch home hospital services. This was even before the CMS Acute Care hospital-at-home waiver launched with the pandemic in 2020. The timeline is important to consider. Then today we operate, as I believe I also mentioned, one of the largest full episode home hospital operations in the nation, and since January of ’22, we’ve served over 2,100 full episodes of care, accounting for more than 10,500 bed days served. It’s important when talking about hospital home programs to really understand the clinical model design. Some, again, are more heavily focused on urgent care, and we are really appreciating the full episode of care.

Right now, we have an average daily census in the 30s with overall bed capacity in the 40s, and we’re on a strong trajectory to scale to about 10% of all capacity being served in the home.

HHCN: I’m curious, how involved is home health care with the hospital-at-home model? Are those different service lines within Healthcare at Home integrated? Can they help each other out?

O’Sullivan: Absolutely. Both the home hospital and home care, again, are addressing our system’s greatest challenge, which is access to care and the capacity crisis that we have. Currently, we are using paramedics in our home hospital model. We are not using paramedics in home care. It’s one of the many differentiators. However, both lines of business sit under the Healthcare at Home division, and, again, in the future, we expect to mobilize the resources and the expertise at home across all lines of business.

HHCN: What have clinical results looked like underneath the model? Have they been more impressive than you thought they may be? How do they compare to the traditional brick-and-mortar acute model?

O’Sullivan: We’re really proud of our focus on research and the transparency to results. We’re all going to get there better together by sharing.

We’ve been privileged to have Dr. David Levine, who led a study in 2019. He’s an internist at the Brigham and Women’s, who investigated the impact of acute care in the home setting, which showed the mean cost of care for patients treated at home was 38% lower than those treated in the typical hospital setting. Those patients utilized significantly fewer lab orders, imaging studies, and consultations. Also, our patients treated at home experienced a readmission rate of 7% within 30 days compared to 23% for those treated in a traditional setting. More recently, another MGB study in 2021 showed that patients receiving this inpatient level of care in their home setting had better experiences with the care team, and better sleep.

I think what’s most exciting is there was really no increase in caregiver burden when the patient was being treated acutely at home or in the hospital. Actually, both are equally taxing and something our industry really needs to solve for.

Overall, the results provide encouragement about the promise of home hospital to continue reduced cost, utilization, and readmission, while improving the patient experience.

HHCN: You mentioned the caregiver burden. Obviously, you said it’s equally taxing, but I have heard that in some cases, some of the workers in hospital at home, they enjoy it because it’s a new kind of work for them. Has that been something that you experienced at MGB?

O’Sullivan: Yes. I’ll say that there was a lot of concern upfront just because the entire health care industry is facing daunting workforce challenges, yet what we’ve experienced in the home hospital, actually it helps us retain our clinical workforce that may otherwise be burnt out in a facility setting. Home hospital allows our clinical workforce to engage and care for their patients in their own home, which both patients and providers are really enjoying. We also have a team of command center clinical staff providing remote coverage, which offers, again, an alternative and increased level of flexibility and variety.

HHCN: The financial outlook, I think, is what everyone’s wondering about the hospital-at-home model. How does it stay afloat way past COVID? What does the outlook look like for you all, and how do you plan to achieve a healthy financial standing in the hospital-at-home model? What are the different avenues of reimbursement that you’re going to explore?

O’Sullivan: Financially, our care model is delivering improved outcomes at lower cost. We’re engaging with all of our payers, and many have already agreed to reimburse for home hospital. Medicare, as you mentioned, has been reimbursing for home hospitals since November of 2020 under the CMS waiver, and MGB was one of only a few of a handful of systems nationally that were grandfathered in due to our strong results in our longstanding efforts operating a home hospital program.

Since then, many state Medicaid programs, including in Massachusetts, understand the importance of reimbursing a home hospital episode, and almost all major commercial payers are also recognizing the tremendous clinical and fiscal benefits of the service. That being said, the regulatory environment is evolving and uncertain, which really necessitates our proactive approach to planning for the future landscape at the federal, state, and local levels. We have been, and we’ll continue to refine the foundational at-home capabilities to meet the future health care ecosystem needs.

HHCN: Has there been anything unexpected about the benefits of shifting more care to the home?

O’Sullivan: Yes, and I’m sure there are more that we will continue to appreciate.

What we’re seeing right off the bat is a multitude of benefits. Home hospital is an imperative approach to increasing access to care by meeting the in-facility demand of our most critically ill patients. We’re avoiding unnecessary cap expenses, alongside delighting our committed clinical workforce, again, with that alternative setting up care option, and, overall, achieving our priority of meeting the expectations of our patients in a manner that they recognize what’s most important to them during a really vulnerable health event. We do this by welcoming the opportunity to be guests in the privacy of their homes and really understanding their communities.

On that point, we’re serving a more diverse patient population than we would’ve expected, and more diverse as compared to our system composition with a broader language and ethnicity mix. We’ve incorporated a number of equity bridges into our care delivery model, and are selecting our partners accordingly. I’m sure a lot of your readers and watchers have noted our recent partnership with Current Health. We understand that it’s really critical to understand the social assessment of the contributors to a patient’s health and wellbeing. We can make an impact in ways that a non-traditional brick-and-mortar setting could not provide. I’m really privileged to have that opportunity.

HHCN: Heather, biggest challenges, you mentioned reimbursement and the regulatory landscape. Is that the biggest challenge still? Also, what are some other challenges that you think the hospital at home program’s going to face?

O’Sullivan: I would say the largest and most significant challenge for a home hospital is orchestrating the complex logistics across internal stakeholders and innovative external partnerships. You can think about simple patient scheduling, clinician scheduling, DME, oxygen, pharmacy, the list is infinite, quite actually, which makes it a fun opportunity. The key lessons in our journey so far include the importance of fostering patient demand and a chicken and egg, which comes first? Do you promote the opportunity or do you build it and they will come? Also, bringing the traditional hospital along with us, some individuals have had double-digit lifelong career trajectories within a brick-and-mortar acute setting, and making sure that they understand what we are accomplishing together and why is a significant change management undertaking. Also, mobilizing existing core strengths from the system that they didn’t realize could be used in a different manner. Again, I mentioned Best Buy earlier, really choosing to partner excellently to continuously enable a focus on clinical outcomes.

HHCN: For those that don’t know, Current Health is Best Buy’s Home Care Technology platform. I believe Best Buy acquired Current Health in 2021. That’s one of your partners now. What was appealing about Best Buy’s value proposition that ultimately had made MGB get into partnership with them?

O’Sullivan: A few things. I’ll say number one, we felt a very strong business cultural alignment. That goes a long way when pioneering into a really unknown space. Additionally, their emphasis and appreciation of our interest in growing the academic opportunities, focusing on the home setting of care as a key priority was well aligned.

Additionally, we felt that their product offering, the remote patient monitoring specifically, was superior to others that exist today, and I know that environment is going to continue to grow. Then, again, the collaboration around logistics expertise and what we need to think creatively about. Outside of Current Health, Best Buy’s experience in the home with the Geek Squad. Our interest in learning from them about their success in engaging consumers is interesting as well.

HHCN: I’m curious, in terms of your outlook for next year, what are you really excited about that MGB is doing with the Healthcare at Home segment? Is there anything that you want to preview in terms of plans in 2024?

O’Sullivan: Grow, scale, execute, those are our themes. Near term, our system is committed to serving 10% of medical inpatient volumes in the home setting. Our leadership understands the rapidly evolving ecosystem, we talked about that, and their commitment will continue to be very strong. Part of that, honestly, is our imperative that our system feels to script a playbook that may be useful to other systems as they understand their “why” in the future of care at home.