Mount Sinai launched Hospitalization at Home (HaH) in 2014 as part of a three-year CMS Innovation Center grant. Since then, Mount Sinai, Contessa and VNSNY partnered to create scale to free up beds across Mount Sinai’s hospitals.

Most patients enrolled in HaH arrive in the emergency room for treatment of an acute condition. In general, patients eligible for care in a HaH program require hospitalization, but also meet other medical and social criteria to ensure that the program is safe and appropriate for them.

To care for more patients, Mount Sinai, Contessa Health, and VNSNY expanded the HaH program to manage the care of patients transferred from the hospital during their hospitalization including Covid-19 patients who are stable enough to be managed at home. Selecting the subgroup of patients eligible for the program is an essential step and helps ensure that patients can be safely managed at home.

Mount Sinai’s hospitalization-at-home program began with a three-year, $9.6 million grant from CMMI in 2014. Since the CMMI grant concluded in 2017, the HaH program has operated by contracting with various payers, including MA plans. The health system formed a joint venture with Contessa Health, a company with expertise in home recovery care, to facilitate the development of contracts with health plans and other payers while helping with certain aspects of care coordination.

To reach more patients amid the pandemic, the Mount Sinai worked with payers and providers in the market to expand. The HaH program now contracts with most high membership payers in the market.

HaH pilot program results paved way for payer expansions

Key to successful contract negotiation, are results from the pilot program that showed better outcomes, fewer complications, more satisfied patients and reduced costs, for patients enrolled in HaH.

An analysis of the clinical data of 295 patients in 2017, found that the program led to improved patient outcomes. Specifically, hospitalization-at-home patients had a 8.6% 30-day readmission rate, which was lower than the 15.6% readmission rate for the control group of acute-care hospital patients. Additionally, hospitalization-at-home patients had an 5.8% 30-day emergency department revisit rate versus an 11.7% ED revisit rate among the control group. Hospitalization-at-home patients were also more likely to report the highest overall rating for overall hospital care in the HCHAPS survey than the control group.

Hospitalization-at-home models need strong home health partners to ensure delivery of quality care and scalability. Mount Sinai and Contessa partner with VNSNY to deliver home care services.

Intensive training prepares RNs for in-home acute care delivery

VNSNY realized that HaH nurses needed to have the experience and skills that make them comfortable delivering care in both the acute care and home setting. As such, nurses hired into the program are RNs and must have a minimum of five years experience delivering care in the hospital acute setting. Additionally, nurses undergo two to four week training program that includes Contessa’s training programs and Mount Sinai’s support in addition to providing hands-on practice on the most common procedures they have to deliver outside the hospital environment including IV infusion, phlebotomy and wound care skills.

Fully trained nurses may spend up to two hours with patients twice a day to administer infusions and medications, perform blood draws, conduct virtual visit with the physician, and educate patients and their families. Lastly, patients can also receive rehabilitation services from VNSNY rehab therapists as needed. VNSNY is supported virtually by Mount Sinai’s and Contessa’s providers that render virtual visits and provide care coordination and oversight using Contessa’s platform, Care Convergence.

Amid the pandemic, VNSNY has had to hire several more nurses and fast track their training and onboarding to support the surge in demand. 30 more nurses are being trained to provide program support.