From dramatic policy and practice change to groundbreaking digital innovation, a new frontier of medicine was born: acute care at home. Also known as hospital-at-home, acute home care is a modern-day hospital imperative that confirms the popular saying “there is no place like home.” This delivery model of care transcends the softer kinds of “home care” commonly delivered by the home health agencies of today. Far more comprehensive, acute home care consists of hospital acute care, post-acute, and primary care, 24/7 remote monitoring, command centers, daily clinician visits, acute and chronic disease management, and other diagnostic services — all delivered in the comfort of one’s home.
If There Is A Silver Lining To The Pandemic, It Is Acute Home Care
Fueled by the pandemic’s necessity for virtual care and the industry’s shift to value-based care, acute home care models are gaining momentum. The fire was ignited by the home-based acute care CMS waiver program, the telehealth boom, and the availability and use of remote patient monitoring (RPM) devices. Currently, 114 systems and 253 hospitals in 37 states are approved for the Acute Care at Home waiver program that allows Medicare payments for additional services in the home. We predict this trend will continue, and acute home care will become mainstream by 2030.
Yet, through our research, we uncovered one handicap to widespread adoption. It unearthed how varying frameworks, delivery methods, and underlying technology systems deter the establishment of a standard operating model. To unpack the ambiguity and assist US hospitals with the formation of an acute home care program, we spent the last year talking to industry-leading vendors and hospitals to learn best practices for a successful deployment. Our recent report, “Acute Home Care: The Best Medicine For US Hospital Systems,” highlights what US hospitals must do to assess their readiness to make the shift to acute home care and devise the right plan of action based on their capabilities, resources, and the patient populations they serve.
Embrace A Pivot To Acute Home Care
Today, acute home care is the tip of the spear, and everyone wants a piece of the $336 billion pie. Health insurers have sharpened their focus on reimbursing acute home care models, and in some cases building out their own capabilities. Retail health disruptors are taking notice as well, with the most recent headlines announcing CVS’s move into the market with its planned $8 billion purchase of the Signify Health, a leader in Health Risk Assessments, value-based care, and provider enablement. But, launching an acute home care model is no easy feat, and standardization and reimbursement challenges inhibit scalable adoption. Forrester is determined to help by equipping clients with the analysis they need to capitalize on acute home care opportunities. Our report highlights the critical steps HCOs must take now to penetrate this dynamic market. But first, we want to give you a sneak peak of our findings. To flourish in the execution of acute home care, HCOs should:
- Preserve nursing staff to keep acute home care from floundering. The most critical asset for the delivery of acute care is, and will always be, its clinical staff. Burnout and staffing shortages must be mitigated for long-term vitality of acute home care programs. Finding qualified staff to support acute home care, and implementing technologies to help close the gap, is the tallest hurdle. HCOs must construct a virtual program where nursing staff are engaged and able to provide sufficient round-the-clock care and surveillance.
- Decrease adverse events and organization expenditures. It’s imperative that acute home care is comprehensive and does not compromise quality. These outcomes can only be achieved with meticulous patient assessment of the patient’s medical state and home environment. Care delivery must be well-coordinated with respect to ancillary support services, community partnerships, and transparency.
- Prioritize conditions with predictable outcomes. HCOs must define clinically appropriate inclusion criteria. Determination depends on patient population, acute exacerbations of chronic conditions with a predictable course of treatment, a virtual care technology portfolio, and available community resources. Solutions are geared toward biometrics screening, social determinants of health, and dynamic treatment regimens for managing acute and chronic disease.
- Remain competitive in digital innovation. HCOs must partner with standard platform templates that are customizable and provide personalized insights. HCOs should start by conducting a comprehensive assessment of their clinical resources and their capacity to deliver care remotely. They should examine their IT infrastructure, EHR, and cloud capabilities to decide what partnerships, if any, are necessary. Leading vendors with a track record of excellence in acute home care should also be identified. HCOs should seek referrals from other HCOs that successfully implemented an acute care at home program as an integral part of their buying journey.
Clear Benefits Exist On The Acute Home Care Road Ahead
The benefits of acute home care include improved mortality, decreased readmissions, decreased length of stay, significant cost reduction, improved functional recovery, overall positive evaluations, lower levels of family member stress, and increased patient satisfaction. In the future of healthcare, the acute home care will be the most innovative and pragmatic solution for managing spiraling healthcare costs, an insurmountable influx of patients, the spread of infectious disease, and the safety of patients and hospital staff. While building out an acute home care delivery model requires overcoming significant obstacles, the benefits are clear. Acute home care helps:
- Break down barriers to care for the elderly and chronically ill. The trend is not new and the data is familiar – in less than two decades, older adults are projected to outnumber children for the first time in US history. Starting in 2030, the elderly will comprise 21% of the population. Acute home care provides accessible lower-cost care for elderly and chronically ill populations that face significant impediments to receiving care within hospital walls. In fact, a survey of 214 elderly patients and their families found that Hospital at Home patients were 4 times more likely than acute care inpatients to be satisfied with their physician; 6.5 times more likely to be satisfied with the convenience of care.
- Lower the cost for under resourced hospitals. Hospital expenditures composed 31.4% of 2019’s $3.8 trillion spend. In 2016, there were 7 million hospital stays in the US, with a rate of 104 stays per 1,000 people. This resulted in over $417 billion in spending with a mean cost per stay of $11,700. A study conducted in 3 cities and including 455 seniors who required admission to an acute care hospital found that the cost per patient day was 32% lower for Hospital at Home patients than for hospital inpatients.
- Prevent hospital-induced patient harm. Every year, approximately 400,000 hospitalized patients experience some type of preventable harm, including medical errors, which cost approximately $20 billion. On any given day, one in 31 US hospital patients has a healthcare-associated infection. An analysis of 61 randomized controlled trials of hospital-at-home programs found that such programs reduced mortality and costs. Patients in the hospital-at-home model compared with those with traditional hospitalizations experience lower rates of delirium and may experience lower rates of falls and infections.
To remain competitive in today’s changing healthcare ecosystem and to make significant strides towards achieving the quintuple aim, hospital systems must take steps now to construct and launch an acute home care model or become obsolete. To learn more about how your hospital can design and execute an acute home care model, read our full report here and stay tuned for our case study highlighting best practices from a major US hospital system.
Senior Analyst Shannon Germain contributed to this blog.