Somerville, Mass.-based Mass General Brigham has built the biggest hospital-at-home program in the country by getting buy-in from leadership and clinicians and through tech partnerships, executives said at a recent conference.
The health system now has a capacity for acute hospital care at home of 70 patients, and is currently treating about 50 to 60 a day. The goal is to move to 10% of Mass General Brigham's overall capacity, or about 200 to 300 patients.
"I'm really thrilled we are the largest home hospital in the country," Mass General Brigham President and CEO Anne Klibanski, MD, said Sept. 23 at the health system's World Medical Innovation Forum in Everett, Mass., covered by Becker's.
She cited the program as a way the health system could stay afloat and thrive amid financial challenges affecting the industry, with lower costs and better outcomes for patients at home. She also said it's a benefit of partnering with tech companies; Best Buy Health provides the in-home technology. "That's what they do. They bring technology into the home," she said. "That's what they're known for."
The program, which Mass General Brigham calls Home Hospital, typically treats patients with conditions like COPD flare-ups, heart failure exacerbations, acute infections and complex cellulitis, according to Mass General Brigham Chief Integration Officer O'Neill Britton, MD.
"It's not typically comfortable to be cared for in the emergency room," Dr. Britton said at the conference.
Beyond that, Mass General Brigham, like many of its peers, deals with capacity strains. He said Sept. 24 that the health system had 185 patients in the emergency department without a bed.
Heather O'Sullivan, APRN, president of Mass General Brigham Healthcare at Home, said it's been estimated that 30% of inpatient care will move to the home in the next five years, representing $82 billion in revenue. "This is a tremendous opportunity," she said at the panel.
Patients are set up with tablets and internet by Best Buy's Geek Squad, and get other needed medical equipment for their "stay" as well. Best Buy purchased remote patient monitoring company Current Health in 2021 for $400 million.
"Technology is our expertise," Best Buy Health COO Chemu Lang'at said during the session. "Healthcare is fragmented. The technology doesn't always connect."
Uncertainty hangs over the future of the care model. The CMS waiver to provide acute hospital care at home expires at the end of 2024; a bill to extend the program recently passed a House committee.
Jatin Dave, MD, chief medical officer for the state's MassHealth Medicaid program, said at the forum that he hopes the home will one day provide a "single infrastructure" for all levels of care: from primary to inpatient care to skilled nursing. He said early research results on ED at home have been "bumpy" while skilled nursing at home looks "fairly optimistic."
"The home is where, in the long run, we can have this full continuum," he said.
Clinicians have also described getting an "extra level of joy" from treating patients at home, meaning it could be a recipe for solving healthcare burnout, he said.
Mass General Brigham has been aiming to expand the program for surgery, oncology and pain management patients, recently admitting its first colorectal surgery patient, Dr. Britton said.
He reminded the audience that the model is not "new." From the dawn of hospitals, wealthy patients would have physicians and nurses come to their homes before technology got so big that those individuals had to come into brick-and-mortar facilities like everyone else, he said. Now, that tech is shrinking in size, from smart devices to wearables.
Australia has also been providing about 10% of inpatient care at home for decades, Dr. Dave said.
But the program requires a lot of logistics, from having vehicles for the nurses to drive to the home visits to getting payers on board. It's "extraordinarily difficult" to scale, Ms. O'Sullivan said.