Intermountain Healthcare to provide hospital-at-home services for some higher-acuity patients

• Intermountain Healthcare on June 4 announced it has launched a service to provide hospital-level care in patients’ homes for certain conditions like congestive heart failure, infections and some cancer diagnoses, according to Healthcare Dive.
• Eligible patients will go through orientation at a hospital first and then receive in-person and virtual check-ins from nurses and doctors, according to the same article.
• Similar models have been implemented by Marshfield Clinic, Ascension, CommonSpirit, Highmark and MetroHealth to provide inpatient level care to low-acuity patients in their home.

On June 5, Healthcare Dive reported: “Intermountain Healthcare has launched a service to provide hospital-level care in patients’ homes for certain conditions like congestive heart failure, infections and some cancer diagnoses. The service is in partnership with the system’s value-based care spinoff Castell and builds on previous efforts to move more treatment into the home.

“It was accelerated by the pandemic and preparation for potential surges of COVID-19 patients, according to a statement published [June 4],” according to the same Healthcare Dive article. “Eligible patients will go through orientation at a hospital first and then receive in-person and virtual check-ins from nurses and doctors,” the article continued. “They will be provided with a remote monitoring kit as well as other home health equipment suited to their diagnosis.”

Similar models have been implemented by Marshfield Clinic, Ascension, CommonSpirit, Highmark and MetroHealth to provide inpatient-level care to low-acuity patients in their homes. The equipment provided by the programs typically includes a blood pressure monitor, pulse oximeter, cellular-enabled digital tablet and a digital scale. Other devices could include a continuous heart rate monitor and oxygen sensor. The equipment will transmit vital signs to a remote monitoring center via Bluetooth.

Takeaway

It makes sense that Intermountain would deploy the hospital-at-home model. Like Marshfield Clinic and Highmark, a large part of its revenue comes from its health insurance business. So deploying the model can create savings that will drop to the bottom line for its Medicare Advantage and other full risk products. And it can help create savings for its Administrative Services Only clients, which should help it win business. Evaluations of the model have also suggested that patients hospitalized at home have better outcomes. However, those results could be influenced by selection bias given these patients should be healthier. Having these capabilities offers a pressure release value at a time when bed capacity could be stretched due to a spike in admissions related to COVID-19.

What’s surprising is that while the Centers for Medicare and Medicaid Services (CMS) greatly expanded providers’ ability to deliver ambulatory care virtually in response to COVID-19, CMS has been silent on using waivers to allow the model to decant low acuity admissions to the home. Not only would this increase available bed capacity, but it could reduce personal protective equipment burn rate given limited in-person staff interaction. While I’m not expecting Centers for Medicare and Medicaid Innovation  to move on the model, the Medicare Physician Technical Advisory Council has previously recommended hospital-at-home models for implementation as alternative payment models.