Oakland, Calif.-based Kaiser Permanente has nearly quadrupled its hospital-at-home capacity in the past year.
Becker's interviewed Hemali Sudhalkar, MD, national medical director of strategy for Kaiser Permanente's Care at Home program, about how the health system's hospital-at-home initiative, which was already one of the biggest in the country, has continued to grow.
Question: What has changed about Kaiser Permanente's hospital-at-home program in the past year?
Hemali Sudhalkar: We have been developing infrastructure to support the program and expand. All our programs are evolving to develop standard operations within their service areas. We're also building patient and staff understanding and confidence in the program. In fact, patients are starting to see our advanced care at home programs as a standard part of the services we offer.
Q: The last time we talked in late 2023, the program had an average daily census of 22-23 patients. Has the average daily census or capacity changed since that time? Is it in any new locations or hospitals?
HS: Our average daily census has grown from 22.5 to 80.6 for the program across all regions, and this includes six areas with Care at Home services, namely Northern California, Southern California, Georgia, Mid-Atlantic states (Maryland, Virginia, and Washington, D.C.), Northwest (Oregon and southwest Washington state), and Washington state.
Q: Has the program added any new conditions or services or otherwise expanded?
HS: We are encouraging more admissions directly from the emergency department along with inpatients. When patients are directly admitted from the emergency room, we improve the efficiency of admission to the program.
Q: What has been the biggest challenge in scaling hospital at home?
HS: The biggest challenge is managing the program across multiple geographic areas and distances within geographic areas.
Another significant challenge has been managing change among patients and clinicians. This includes educating our patients and caregivers about the program. In addition, we have had to develop the infrastructure for what is essentially a startup, while also assisting our physicians and care teams in transitioning to a different model of care.
It is crucial to invest in infrastructure, and there is an upfront cost while you're working to grow and scale the program. It requires a lot of time in learning and in training physicians and staff. As we grow, the economies of scale improve, and the program becomes more affordable.
Q: Is there a benefit to the program that surprised you?
HS: Yes, what's surprised us is how much our patients love this program. They tell us that they are much more comfortable in their own homes.
Furthermore, because our healthcare team is going into the patient's home, we gain insights into social determinants of health that may be impacting the patient. For example, we can see whether they have access to safe and nutritious food and what other medications they may be taking that could interfere with medications we're prescribing.
Q: Where do you see hospital at home going next year?
HS: We would love to expand in different service lines and service areas as well as point of entry, not just from emergency departments and hospitals. For example, we would like to expand to include dialysis patients, and to include some patients who are already enrolled in home health programs if they become acutely ill.