Mayo Clinic's hospital-at-home program has expanded in the past year but will need the equivalent of an "Uber app" to scale, a leader told Becker's.
The Rochester, Minn.-based health system's acute hospital care at home initiative has grown to an average daily census of 30 to 35 patients a day. But the biggest challenge remains how to successfully "orchestrate" the care model, said Michael Maniaci, MD, chief clinical officer of advanced care at home for Mayo Clinic. He compared it to the actual rideshare platform.
"Imagine an Uber app where the car chassis, the tires, the fuel, the engine and the driver all show up separately," he said. "You have the tubing coming from someplace, prescription medication coming from another place, the nurse coming from one place, the DME and the pump coming from another place — and they all have to show up at the same time."
If a company or app can unify hospital at home's staffing, supply and technology needs in one platform — say, what Epic did for EHRs — the care model will take off, Dr. Maniaci said.
"I've got the patients. I've got the buy-in. I have the clinicians who know the care plans. I have the protocols," he said. "Now, the administration of this ecosystem is the next big thing."
Mayo Clinic offers hospital at home in Florida, Wisconsin and Arizona, with the Sunshine State having the largest capacity (Wisconsin is too rural, while Arizona doesn't allow paramedics to provide the twice daily in-person visits required by CMS so only uses nurses, he said).
"In our Florida site we can do 22 patients, and that's limited not by the number of patients we have in the hospital but the actual care delivery system," Dr. Maniaci said. "I need that Uber app to help get past that number."
Despite these obstacles, Mayo Clinic has extended at-home care to chemotherapy infusions and chronically ill patients in need of urgent or emergency care, with plans to move into observational and post-acute care. The health system has been experimenting with point-of-care labs, bedside medication delivery, wearables that passively gather data, and artificial intelligence for patient acquisition.
"All these things live off the same foundation and centralized command center across the enterprise, but with different levels of acuity to deliver home care and hopefully keep people away from buildings they don't want to go to," Dr. Maniaci said. "We really need to help in the technological world to drive forward care orchestration. Once we get that in place, the sky's the limit with this decentralized ecosystem of care."