Analysis: Hospital at home will move inpatient admissions into the home

• Highmark Health is introducing a program to deliver inpatient hospital care to patients in their homes, according to a Modern Healthcare article.
• Other healthcare systems have deployed the model with positive results.
• For acute care providers, participating in a hospital-at-home model likely will decrease revenue related to the impacted MS-DRGs, according to HFMA’s Chad Mulvany.

Modern Healthcare is reporting, “Highmark Health, the parent company of Pittsburgh-based Blues insurer Highmark and integrated system Allegheny Health Network, is introducing a program to deliver inpatient hospital care to patients in their homes, where it says certain healthcare services can be provided in a safer, lower cost way through a combination of in-person home visits and telehealth. Highmark Health is now rolling its program out to certain commercial plan members in Western Pennsylvania and will expand it to Medicare Advantage members on Jan. 1. It has plans to push the program out to all of its members in central and Western Pennsylvania in the next year.

“When patients come to the ED, coordinators will screen them to see if their conditions can be treated at home and if they are Highmark’s health plan member. Eligible patents may get the option to be transported home to receive inpatient care, so long as their homes are generally safe for the patient and caregiver, meaning they have central air or heat and water, for instance. Once at home, the patients begin 30-day episodes of care. During the first few days, nurses visit the home twice a day to check vital signs, conduct basic lab tests and give infusion services, and once a day the nurse and patient check in virtually with an Allegheny Health Network hospitalist. For the rest of the period, the patient will be monitored via a telehealth kit left in the home.”

Article highlights

According to the Modern Healthcare article:

• Highmark patients receive a visit an average of 27 times over the 30-day episode, either in-person, virtually or by telephone. 
• Highmark will provide home hospitalization services for 44 different conditions, including pneumonia, chronic obstructive pulmonary disease, congestive heart failure, cellulitis and diverticulitis.
• The medical conditions included in the program account for about 40% of hospitalizations.
• Studies of other hospital-at-home programs have shown the models result in fewer readmissions and emergency department visits and reported a better patient experience than patients who stayed at the hospital.

Takeaway

It’s not surprising that an aligned integrated delivery system like Highmark would implement a hospital- at-home model. Other similar systems like Marshfield Clinic in Marshfield, Wisconsin and Presbyterian Health System in New Mexico have deployed the model with positive results. And Humana has indicated that it will start offering its members in-home care through its Kindred acquisition for low-acuity conditions that typically require a hospitalization.

Medicare fee for service does not cover home hospitalizations, but the Physician-Focused Payment Model Technical Advisory Committee (which is provided with technical and operational support by the Department of Health and Human Services, acting through the Office of the Assistant Secretary for Planning and Evaluation) has recommended the hospital-at-home model for development through CMMI. Thus far, CMMI has not moved on that recommendation but it wouldn’t surprise me if they eventually did.

For acute care providers, participating in a hospital-at-home model likely will decrease revenue related to the impacted MS-DRGs. Like other services that are migrating out of the hospital setting,  the question management teams need to answer is whether there’s greater financial risk in cannibalizing this revenue stream or ceding the volume to other, well-positioned competitors who may offer the service. As part of this analysis, systems will need to understand their exposure, opportunity, market and capabilities.

Details of hospital-at-home model

An HFMA article “Home is Where the Hospital Is”  provides more detail on the hospital-at-home model and strategic considerations for health systems.