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4 steps to develop a successful Hospital at Home program

May 28, 2019

    Editor's note: A version of this post previously ran in the Daily Briefing.

    Systems view Hospital at Home (HaH) with renewed enthusiasm. These programs can improve patient satisfaction and total cost of care. CMS may approve HaH as an alternative payment model under MACRA, making it more financially feasible.

    New tool: The Post-acute Care Performance Improvement Assessment

    HaH's track record of success

    HaH models provide inpatient-level care through home visits with a physician and nurse. Patient experience improvements of HaH stem from avoiding the noise, cost, and discomfort of a hospitalization. For example, patients participating in Mount Sinai's HaH program reported the highest overall rating for care in the HCHAPS survey compared with a control group.

    Further, several HaH programs reduce costs, help providers avoid bed shortages, and maintain equivalent patient safety and clinical outcomes. At Mount Sinai, acute utilization was significantly lower for HaH patients compared with the control group:

    • 30-day readmission rate was 8.6%, compared with 15.6% for the control group; and
    • 30-day ED revisit rate was 5.8%, compared with 11.7% for the control group.

    4 steps to develop a successful HaH program

    So what makes models like Mount Sinai's work? In our research, we've noticed that top-performing HaH programs share four common characteristics. Here, we distill our findings into four actions providers should take ensure a program's success.

    1. Determine your target patient population through eligibility criteria, payer status, and geographic location.

      Programs need clear inclusion criteria to avoid becoming overwhelmed. Criteria can be based on condition (e.g., CHF, COPD, cellulitis, delirium), insurance plan, and/or patient location. For instance, patients should reside within a certain distance of a qualifying hospital to minimize staff travel time and ensure the patient can be transported to an ED in a timely manner if necessary.

    2. Select staff who have experience treating patients in their homes.

      HaH programs require providers to work independently, without the assistance of peers. They are not the ideal placement for new staff, who are more costly to train in these settings. Successful programs tend to engage experienced providers who are already comfortable treating patients through house calls and are engaged in the benefits of HaH.

    3. Get specialized program support by creating close partnerships with key service lines.

      HaH programs depend on many partners to optimize home-based care delivery. Incorporating leaders from critical service lines into the planning process—such as imaging services and pharmacy support—ensures comprehensive, hospital-level care. Simultaneously, service line engagement raises awareness of HaH throughout the health system prior to launch.  

    4. Manage patients beyond discharge from Hospital at Home.

      Advanced programs support patients even after they are "discharged" from hospital-level care. For instance, Mount Sinai's average length of stay in HaH is 3.5 days, the approximate time the patient would have been in the hospital. After that, patients have full access to nurses and social workers for an additional 30 days. Other programs take a more step-down approach where home visits slowly decrease in number until the patient is ready to graduate from the program. Regardless of the approach, a planned process for continued care is essential to ensure the patient's recovery and minimize readmissions.

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