Hospital-at-home programs are rapidly transforming American healthcare delivery, providing a transformational model of care that combines convenience, quality and cost-efficiency. While some current opinion highlights the challenges of hospital-at-home programs, the discussions often overlook the success and potential of a "built-from-within" approach.
Health systems that fully integrate, or what we like to call "built-from-within" hospital-at-home programs — like Tampa General Hospital's TGH at Home — are proving superior patient outcomes well above the national average, strong program growth and highly rated patient and provider satisfaction. Additionally, thanks to strategic partnerships like the one TGH has with Shields Health Innovations, we designed a program built for scale that allows us to move quickly.
Understanding Hospital-at-Home
Understanding acute hospital care at home — what it is and what it is not — is a key point of distinction. Some health systems rebrand their traditional home health services and ambulatory chronic care management and label it “hospital-at-home.” This confusion misleads patients, artificially inflates census numbers and undermines the integrity and value of true hospital-at-home models, which provide hospital-level care for acute conditions typically cared for within the walls of a hospital. It is essential to understand that hospital-at-home is a distinct service focused on delivering inpatient care in a patient’s home and not an extension of standard home health or ambulatory care at home.
Vendor-Led vs. Built-From-Within
Control and trust are key distinctions between the "built-from-within" or fully integrated approach and vendor-led models. Vendor-led models rely on outsourced staff and operations, including nurses not employed by the partnering health system. Vendors often struggle with hiring in a local market, as their staff feel disconnected from the hospital and the patients they serve. This disconnect erodes trust and coordination between hospital-based and at-home care teams, leading to a reluctance among physicians to transition higher acuity patients from hospital to home.
Built-from-within models, like TGH at Home, avoid these pitfalls by employing and directly engaging its team within the health system. In TGH’s case, this approach has yielded exceptional results, with team member engagement scores consistently ranking in the top decile nationally, low hiring turnaround times and under 3% team member turnover since inception. Such high engagement not only supports staffing stability but also fosters a culture of trust and collaboration, further enabling the program to scale.
Additionally, vendor-led models use separate electronic medical records systems from the hospitals they support, leading to a breakdown in the continuity of care. In the built-from-within approach, patient records are documented in a unified EMR for continuity and efficient information exchange.
Most importantly, as seen in the built-from-within model, an alignment to confidently expand both higher acuity care and higher patient volumes is created by ensuring team members and clinicians feel integrated into the hospital's mission and culture. Since June 2022, TGH at Home has cared for about 1,000 patients with 150-plus conditions, saving over 4,000 bed days. But it is the patient outcomes that speak for themselves. Despite higher acuity cases, TGH at Home consistently boasts top decile patient experience scores. While the national average for standard readmission rates for patients with similar conditions is 16%-18%, the TGH at Home patient readmission rate is a mere 5%.
Partnering for Ultimate Success
When building a program from within, we believe that a health system's priority is to "own the care;" however, close partnerships need to be considered for scale and speed. TGH chose to leverage the "build-from-within" approach for care coupled with a transformative partnership with Shields Health Innovations — combining our proven health system expertise with Shields’ national reach and health care innovation platform to create Shields at Home. Together, TGH and Shields built TGH's hospital-at-home program brick by brick, from the inside out. As a guiding principle, TGH controlled clinical care delivery provided by TGH clinicians, while Shields provided program management for logistics and analytics. This partnership focused on building TGH's hospital-at-home program for the first year. The success of TGH's hospital-at-home program later solidified the foundation for expanding the hospital-at-home model to health systems nationwide, fostering systemic improvements in hospital-at-home care delivery.
While outsourced hospital-at-home models face significant hurdles, the built-from-within plus partner approach exemplified by TGH and Shields at Home proves the immense promise of this care model. In a healthcare landscape that increasingly values efficiency and patient-centered solutions, hospital-at-home represents a viable alternative and a necessary evolution. TGH at Home demonstrates that focusing on quality care and a unique partnership with Shields at Home can scale hospital-at-home programs without compromising quality, safety or experience. Hospital-at-home is not just a temporary solution but a transformative opportunity to reimagine care delivery.
Peter Chang, MD, is senior vice president and chief transformation officer at Tampa General Hospital. You can follow him on LinkedIn here.
John Couris is the president and CEO of the Florida Health Sciences Center – Tampa General Hospital. You can follow him on LinkedIn here.