While many health systems have home health and hospice services, few have expanded these services to incorporate hospital-at-home models. However, as expectations for lower-cost care and higher quality continue to rise, the further expansion to home hospital models will be necessary.
In a June Becker's Hospital Review webinar sponsored by Alternate Solutions Health Network, five healthcare executives discussed the industry dynamics driving in-home care and the four key elements needed to expand home healthcare to a strong home hospital program.
Presenters, all from Alternate Solutions Health Network, were:
- Chad Creech, chief strategy and integration officer
- Jeff Forshee, senior vice president of business development
- Neeraj Jotsinghani, chief information officer
- Everett Neal, president
- Teri Sholder, chief quality officer
Three key takeaways were:
1. Demand for in-home care is being driven by consumer expectations and value-based care models focused on lowering costs while improving quality. "Patients are becoming consumers," Mr. Forshee said. "Health systems are transitioning to lower-cost settings." It's an opportunity for those on the post-acute side to improve volume, reimbursement, quality and outcomes. Hospital-at-home is one way to do so.
2. A strong home care program requires a strong foundation. Key elements of this foundation are care coordination, quality and outcomes, efficient operations and data integration and analytics.
- Care coordination. Home health needs to be integrated with hospital emergency rooms, skilled nursing facilities, community care coordinators and assisted living and rehabilitation centers. "The hospital-at-home model lies on top of that home health foundation," Mr. Creech said. "We take an educational perspective with patients, families, physicians and other practitioners, sharing available in-home services."
- Quality and outcomes. Ms. Sholder suggested starting your hospital-at-home program with a strategic group of patients to ensure high quality. "Focusing your program on a lower-complexity population with well-defined clinical protocols and treatment guidelines can lead to more reliable outcomes," she said.
- Efficient operations. Mr. Neal warned that the transition from home health to hospital-at-home is rife with complexities. "A home health organization is typically built around a 2 percent change per day," he explained. "When you move the hospital at home, those patients have a much shorter length of stay so your daily turnover rate might be 10 or 15 times higher." More extensive coordination and training will be required for home hospital nurses to deal with different clinical pathways, remote monitoring devices and the complex logistical needs of hospital-at-home.
- Data and analytics. A centralized technology infrastructure is required and "data integration is key," Mr. Jotsinghani said. "The concept of integration must go way beyond systems talking to each other. The model must factor how we can aggregate, mine, analyze and present data efficiently within an ecosystem of applications."
3. Home hospital can help health systems reach value-based goals, improving patient outcomes and experience while reducing costs, along with many other benefits. Both patients and providers benefit from the home hospital model of care. "Integrated home health results in high levels of satisfaction as a consistent care team is focused on each patient's needs in the home," Mr. Creech said.
Ms. Sholder noted that patients who stay home go about their daily tasks naturally and move around, which reduces other risks. "We're seeing psychosocial benefits from patients staying in familiar surroundings," she said. "They are more mobile in the home environment, which mitigates risk of adverse events like falls."
Finally, Mr. Forshee pointed out the financial benefits of home hospital. "Hospital home has proven to be effective at lowering costs by about 30 percent. It also lowers the patient's length of stay, reduces complications and readmission rates and improves patient experiences and outcomes."
It is clear that hospital-at-home is an inevitable trend. The question is how to do it most effectively and efficiently. Partners such as Alternate Solutions can help health systems build the foundation they need to succeed in this space.
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