A new  study from researchers at Mass General Brigham found positive outcomes among patients who receive care at home. While the benefits of hospital-at-home programs (HaH) programs are compelling, establishing a successful program brings its own set of challenges. But Advisory Board’s Miriam Sznycer-Taub offers four key steps for organizations looking to launch — or expand — a successful HaH program. 

Our take: The future of the acute care at home model

Study findings and key details

In 2020, CMS launched the Acute Hospital Care at Home (AHCaH) Waiver, which resulted in thousands of patients across 300 hospitals in 37 states receiving acute care in their homes.

To better understand these patients' outcomes on a national level, researchers at Mass General Brigham analyzed Medicare fee-for-service claims filed between July 1, 2022, and June 30, 2023, for all 5,858 patients who received care under the AHCaH waiver.

In total, 54% of the patients were women, 85.2% were white, 61.8% were older than 75 years of age, and 18.1% were disabled. In addition, 42.5% of the patients had heart failure, 43.3% had chronic obstructive pulmonary disease, 22.1% had cancer, and 16.1% had dementia.

When looking at the hospitalizations included in the study, the researchers found a 0.5% mortality rate and a 6.2% escalation rate, with patients returning to the hospital for at least 24 hours. In the 30 days following a discharge, they found that just 2.6% of patients were in a skilled nursing facility, 3.2% died, and 15.6% had been readmitted.

Notably, the researchers found that the outcomes were consistent across all groups represented in the study.

"It was reassuring to see that there were not clinically meaningful differences in outcomes across marginalized populations, because we know that there are massive disparities in outcomes for traditional hospitalization," said David Michael Levine, study author and clinical director for research and development for Mass General Brigham's HaH program. "This suggests home hospital can really reach a diverse group of patients and families."

Because the study was observational, the researchers did not compare mortality and readmission rates among patients who received care under the AHCaH waiver with patients who received care in hospitals. According to Levine, additional research is needed to compare outcomes among HaH patients with those who are cared for in hospitals.

However, Levine noted that "[t]here are a number of reasons we think hospital-level care is better at home."

"For one, the discharge process is smoother since we show patients how to take care of themselves right in their homes, where they are also more likely to be upright and move more. In addition, the clinical team has a greater ability to educate and act on the social determinants of health that we see in the home," Levine said. "For example, we can discuss a patient's diet right in the kitchen or link a patient with resources when we see the cupboards are bare."

What does the future of HaH hold?

According to Modern Healthcare, the findings of Mass General Brigham's study are consistent with a larger study published in JAMA Health Forum, which found a 0.3% mortality rate and a 7.2% rehospitalization rate among over 11,000 patients enrolled in HaH programs between Nov. 25, 2021, and March 20, 2023.

While many health systems are betting big on HaH programs, the future of HaH remains uncertain. Unless Congress intervenes, the AHCaH waiver will expire in December. According to Levine, both studies provide compelling evidence to support the continuation of this program.

"For hundreds of years, since the inception of hospitals, we've told patients to go to a hospital to get acute medical care. But in the last 40 years, there's been a global movement to bring care back to the home," Levine said. "We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home."

While "[h]ospitalization is the standard of care for acute illness," the study authors noted that "hospital care is often expensive, unsafe, and uncomfortable."

"This [research] speaks volumes to the type of care the model can deliver and that many patients can do well when they go home with this care model," Levine said. (Mass General Brigham news release, 1/8; Eastabrook, Modern Healthcare, 1/9; Thompson, U.S. News & World Report, 1/9; Levine et al., Annals of Internal Medicine, 1/9)