Hospital-at-home expansion ignites quality concerns


Hospital-at-home pioneers often rely on partnerships with vendors and insurance companies to navigate challenges with technology and reimbursement.

Rochester, Minnesota-based Mayo Clinic’s Advanced Care at Home program, which started in January 2020, works with Medically Home. In 2021, Mayo Clinic, along with Oakland, California-based Kaiser Permanente, invested $100 million in the company.

As part of all its partnerships with health systems, Medically Home helps identify the right physicians and nurses to participate in the model; installs devices such as Bluetooth-enabled blood pressure cuffs, scales and stethoscopes in patient homes; sets up performance and clinical outcomes dashboards; and ensures data are sent to patients’ electronic health records. The entire program implementation process can take up to six months.

“First we figure out what we need to get the right data, and then our partner Medically Home goes out and they find the vendors of these devices,” said Dr. Michael Maniaci, medical director of Mayo’s Advanced Care at Home program.

A bedside tablet acts as a hub, displaying patients’ daily schedules, providing information on their conditions, and allowing them to take pictures of physical symptoms and communicate via video with nurses and physicians. Tablet data feed into a central command center, which the health system uses to coordinate virtual visits and dispatch on-staff clinicians to patients’ homes twice a day to administer treatment such as injections.

Over the past two years, the program has served nearly 3,500 hospital-at-home patients, who have received about 7,500 days’ worth of at-home services. Around 85% of the patients are Medicare or Medicaid beneficiaries, whose care is covered by CMS’ current waiver. For those with commercial insurance, the health system’s payer relations teams try to make deals to cover their treatment, building individual relationships with insurers on a state-by-state basis, Maniaci said.

The health system said its 30-day readmission rates for hospital-at-home care have been lower than rates at its brick-and-mortar facilities, though it did not provide specific numbers. It also declined to say how much money has gone into the program. But Maniaci said the investment has proven worth it so far, with quality metrics on mortality and patient safety equal to or better than those in the hospital setting. More than 90% of Advanced Care at Home patients report being satisfied with their care experience, he said.

In the long run, Maniaci said Mayo expects to save 10% to 15% in costs while implementing the program at scale.

“You have to take care of a good 25 to 30 patients as an average daily census to at least break even or make this affordable,” he said. “But for now, we really want to push the care model and show that it works and it’s a better way of caring for people.”

Leaders in the medical community are coming together to work with government officials and help write the rules for quality and safety standards in hospital-at-home care, Maniaci said.

“We, along with others that we partnered with, have learned a lot,” he said. “We have a coalition of multiple academic institutions where we sit down and just talk.”

Some systems use simulations to try to preemptively address any issues concerning equipment set-up, connection, clinician response time and care quality. Wilmington, Delaware-based ChristianaCare requires its hospital-at-home team of nurses, advanced practice clinicians and digital experts to undergo three weeks of training.

“If any part of that simulation failed, we started over,” said Patty Resnik, vice president of operations for the ChristianaCare Center for Virtual Health. “This is very intensive work.”

The health system launched its Hospital Care at Home program at the end of 2021, also in partnership with Medically Home. Most of the 200 patients it’s treated so far are Medicare beneficiaries experiencing conditions such as COVID-19, chronic obstructive pulmonary disease, heart failure, sepsis and cellulitis.


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