Like many organizations, Intermountain Healthcare built a hospital at home program within a matter of weeks early in the pandemic.
The system was not starting from the ground up. It had an existing virtual hospital program and a tele-platform already in place, as well as a proprietary in-home health company, and it had previously made early forays into remote patient monitoring.
“When it came putting it altogether, we were able to do it quickly,” says Nathan Starr, DO, Medical Director of Home Services for Intermountain at Home.
Now, nearly two years since that initiative began, the program has grown from supporting Intermountain during the pandemic to being a critical element of its long-term vision moving forward.
At Intermountain and more broadly across the health care landscape, the shift toward delivering more care in the home and advancing new models for doing so began long before the emergence of COVID-19. That said, the pandemic accelerated the need for home-based care and highlighted the opportunities.
Opportunities for health at home in the future
Across the country, health systems, health plans and other organizations are thinking similarly to Intermountain about moving more care into the home.
As much as $265 billion of care services — representing up to 25 percent of the total cost of care for Medicare FFS and Medicare Advantage beneficiaries — could shift from traditional facilities to the home by 2025, a recent analysis by McKinsey found.
New models of care will be among the topics at the Health Evolution Summit, April 6-8. Apply to participate.
An overwhelming majority of people who have received home-based care, in fact, were satisfied (88 percent) and would be likely to recommend to family and friends (85 percent), according to a survey released by Moving Health Home, a coalition of health care organizations advocating for improved access to home-based care.
In Intermountain’s case, Starr says patients have not encountered any serious events at the home and people in the program experience lower readmission rates than those outside the program. Plus, overall costs are down. From a satisfaction perspective, they have enjoyed the experience a lot more than an inpatient bed and, at least anecdotally, patients have told Starr that they are happy to be at home and having that option has made a difference in their care.
“When we enroll someone and send them home from the emergency department, we have an intensive training and onboarding process. We have a team that educates the patients, families and caregivers,” says Starr. “We try to level-set expectations so when they get home, they understand the process. That’s really gone well. What we’ve found is patients like eating their own food, sleeping in their own bed, having their pets around and seeing their family.”
Calling on CMS to continue flexibility on home-based care models
The success of health at home initiatives currently has leading health care organizations banding together and asking the government to continue its flexibility on hospital at home reimbursement — an effort Intermountain is a part of despite not participating in the waiver program.
Currently, CMS’ Acute Hospital Care at Home program allows eligible hospitals the regulatory flexibility needed to treat eligible patients in their homes via telemedicine and virtual health technologies. The program was announced in November 2020 and will be in place for the duration of the COVID-19 public health emergency.
While Intermountain supports an expansion of the waiver, it wants to see an acknowledgement of the cost savings that hospital at home can bring patients compared to a regular inpatient stay.
“We’re not actually participating in that waiver. We do support it though and want to see it expanded while they create something more permanent,” Starr says. “The reason we’re not participating is the waiver pays a full DRG for moving everything you’d do in a hospital into the home. Our model, as it currently exists and what we fundamentally believe, is that this should be a cheaper amount. Instead of everything the patient receives in the home, it should be just what they need, so there’s a cost saving for the patient, payer, and the health system. Either way, there’s so much momentum for hospital at home, we need to move it forward.”
Early lessons learned
Although Intermountain’s program has been a success, it still faces challenges: payment models, technology, equity issues, social determinants of health, and identifying appropriate patient populations for home care services.
Perhaps the most important long-term issue is the payment structure for home at health models of care, which is why Intermountain and others are leading these industry coalitions.
Beyond the payment problem, Starr says that remote patient monitoring technology has been good but unreliable. As tech capabilities become more reliable, however, Intermountain is expecting new opportunities to open that will help the program expand to more patient populations.
To this end, it can be difficult to provide this program to patients in under-resourced communities. Rural areas, for example, hold considerable potential for virtual and home-based care, yet many still lack the necessary access to broadband internet.
“We want to be equitable, and we recognize that a lot of our vulnerable patients have home insecurity, food insecurity and a lot of these social determinants of health,” Starr says. “We often don’t understand the magnitude of those problems until we’re in the home.”
Another challenge for the program is identifying the right patient population. Starr says that Intermountain started off with a safe patient population and then slowly pushed the limits.
Ultimately, what has worked for Intermountain won’t necessarily work for other organizations. For those health systems and plans who are starting down the path of creating their own hospital at home program, he says that they should recognize that there is no standard model.
“As an industry, we’re still learning what works and what doesn’t,” Starr says. “You have to view this as a long play. You’ll have to stand up a few resources — it’s cheaper than a brick-and-mortar hospital for sure — but it’s going to take time to build trust with the doctors to send a patient home. You have to be patient.”
Photo credit: Intermountain Healthcare