Does hospital-at-home signify the coming of a new model? Or is it just another program to dabble in?
Like value-based care, we all can love the ideas and hope of what hospital-at-home will bring to the system. Having worked in the hospital, I’ve seen the patients hospitals would love to punt to home - but why couldn’t they? Often, the lack of social support or lack of community based support services prevented a safe discharge home. If we think about why hospitals save money, I think of the ideal use case for them - an unpaid family caregiver. If this person is in place, hospitals can discharge home to save costs on staffing, supplies, possibly meds, and food. That’s my fear of abuse of these programs. My hope is this model drives hospitals to have incentives to work better with community based programs. The pieces are all there - mobile X-ray, pharmacy delivery, home care, therapy, dialysis, transportation, care management - but the missing piece is a lead to be paid to coordinate all these pieces for the patient. The payment has not been high enough to incentivize any change or working together. All policies and admin seem to focus on is cost savings but saving money has yet to create sustainable ideas in healthcare.
Right now most of the discussion and implementation of H@H programs is from the institutional perspective of shifting low-to-medium acuity patients to the home, which I'm all for and makes complete sense. Where I believe (and hope) the real opportunity lies is with independent providers -- not the hospital health system as you describe here -- but in private care delivery companies in partnership with MA Health Plans providing H@H services. As of now the CMS waiver does not work with this particular opportunity. My company wants to provide an integrated ecosystem of care for older adults at home throughout their entire care journey -- from Primary Care, to Acute Care (Urgent Care & H@H), Post-Acute Care (think of SNF@Home) and Palliative Care.