< + > Effective and Lasting Hospital-at-Home Solutions Require Intentional Innovation and Design

The following is a guest article by Jay Mathur, MD, Regional Medical Director at Contessa Health and Inlightened Expert 

As a practicing hospitalist designing and delivering hospital-at-home programs across the country, I’m excited about a future where we can expand this kind of care to more Americans. The need to expand the way we deliver care is clear:

• By 2040, about one in five Americans will be age 65 or older 
• Not only is the population aging, but people are living longer; the number of Americans ages 100 and older is projected to more than quadruple over the next three decades 
• Hospitals are about as full as they ever were during the pandemic; at least three-quarters of available beds across the country were in use for all of 2022

Hospital-at-home keeps care/patients at home and delivers better outcomes, which is a win for patients, health systems, and payers. But it’s not something we can pull together overnight. Rather, an effective and lasting hospital-at-home solution requires significant thought, planning, and collaboration.

Start by Asking – and Answering – the Critical Questions  

First, what is the problem we’re trying to solve?

Each health system, patient population, and provider group might have their own unique problem they’re looking to solve, and the hospital-at-home program becomes the solution. For example, it can solve capacity constraints, additional care offerings, patient satisfaction, or transitions of care which require unique focus and attention.

The answer to What are we trying to impact? should become your North Star.

Second, who needs to be involved?

Sustainable hospital-at-home programs require a top-to-bottom approach; a lasting program requires strong system buy-in at the top level. Since you are trying to replicate the hospital environment at home – clinical care, clinicians, supply chains, and operations – it will be difficult to provide effective care if there is any misalignment. That buy-in ensures every aspect of the hospital or system is involved and invested and wants to see it succeed.

You also need a ground-up approach in order to demonstrate value to patients and the individuals caring for them. The person interacting with the patient must see profound value and understand how it works and how it could impact care. You should strive for a strong sense of collaboration and teamwork between members of the care team.

Make Space for Trial and Error 

No matter how much we want everything to be perfect before the first patient is treated, the reality is the program will evolve and improve over time.

A health system is complex and this new way of delivering care is no different. Over time, you will identify what is necessary to drive in-patient outcomes and provide in-patient levels of care, all in a person’s home. But, until you treat that first patient, it’s a theoretical process no matter how prepared you are.

The best programs recognize that early on and make space for the inevitable adjustments. Of course, you need to put safeguards into place to make sure you’re effectively and safely going to treat those first patients; but, with experience, you will learn how to layer other things in to deliver the most effective care possible, build out other patient populations, and what you need to scale back on.

Ensure the Right Team is in Place 

The team should be made up of individuals both remote and in-person, as they will have to replicate in-patient care and oversee care management to provide effective care. Traditionally, a physician or provider will be in the hospital or a central location rounding on patients virtually, a nurse will go into the home twice a day, and other specialists – e.g., occupational, physical, or respiratory therapist – will visit as needed.

A virtual care unit must be set up, which consists of nurses and care managers, available 24/7, in order to address any patient concerns and triage escalation/concerns that need to be escalated to the hospital.

A critical role for any hospital-at-home program is a specialized coordinator (at Contessa, we call this an RCC: Recovery Care Coordinator). This individual or team helps cut through barriers in the hospital to figure out how to replicate services at home; for example, making sure oxygen, antibiotics, and/or IV meds get to a patient’s house in a timely fashion.

Keep in mind this is a novel care model, so the team – and everyone involved – will need to be flexible, patient, and committed to the vision for the program.

Determine Technology’s Role 

Consider where technology can help solve problems, not create a distraction. When thinking about the technology that will be used for the program, have a conversation with the technology community to ensure they are developing tools for this niche use case. Every tool must be effective – and add to the quality of care – in all of those environments.

Here are some questions to consider: 

• How do we think about the home as a space to deliver multiple levels of care (e.g., post-acute, palliative, or complex care)?
• What do clinicians believe is important for technology to solve in the home?
• Can we show the technology leads to better patient outcomes as defined by the clinical teams?

We need to see home as the final frontier of healthcare and as an individual space to perform multiple levels of care, and must work with our technology partners to ensure they understand this new care model.

I have seen the value a hospital-at-home program delivers: improved outcomes for patients, benefits to payers, and solutions for health systems – all by keeping someone at home. Looking into a future with an aging population, a provider shortage, and longer lifespans, I’m more convinced than ever that this is a direction in which we must go.

There’s no question we have work to do across the healthcare system; it will take many of us working together to make this a reality – and an option – for all Americans. Having seen the incredible work already being done in this space, I am extremely optimistic we will take the steps necessary to respond to that future with lasting hospital-at-home solutions.

About Jay Mathur

Jay Mathur, MD, is an internal medicine physician and practicing hospitalist and has served as an assistant clinical professor of medicine. As an advocate for delivering hospital-level care in the home, he is passionate about utilizing technology and innovation to drive better outcomes for patients and providers. That vision brought him to Contessa, where his role as Regional Medical Director allows him to collaborate with clinicians and health system leaders to successfully implement hospital-at-home models. In addition to his role with Contessa, Dr. Mathur provides consulting and advisory through Inlightened.