Hospital-at-home programs, also known as home hospitalization or home-based acute care, refer to a model of care that allows patients to receive hospital-level treatment in the comfort of their own homes.
Under this program, patients who would typically require hospitalization are instead monitored and treated by a team of healthcare professionals in their home setting. This team of healthcare professionals can include physicians, nurses, therapists, and other support staff.
The hospital at home program or HAH is typically used for patients who have acute medical conditions that require hospital-level care, but who are otherwise stable and do not require intensive care or surgery. Patients who may be eligible for this program include those with pneumonia, congestive heart failure, chronic obstructive pulmonary disease (COPD), and cellulitis, among other conditions.
The HAH program has been shown to offer several benefits over traditional hospitalization, including improved patient outcomes, reduced healthcare costs, and increased patient satisfaction. Patients in this program are often able to recover more quickly in their familiar environment, and may also experience less risk of hospital-acquired infections.
Barriers to HAH programs
Hospital-at-home programs have the potential to provide cost-effective care to patients with acute medical conditions, but several payment barriers may limit the adoption of this model of care. Here are some of the payment barriers and ways to overcome them:
Currently, hospital-at-home services are not reimbursed by all payers, which can make it challenging for hospitals to offer these programs. To overcome this barrier, hospitals can work with payers to negotiate reimbursement rates for home-based acute care services. Payers may be more willing to pay for these services if they can be shown to reduce healthcare costs and improve patient outcomes.
No standardized payment models
There is no specific payment model for hospital-at-home services, which can make it difficult for hospitals to determine how to bill for these services. To address this barrier, hospitals can work with industry groups and payers to develop standardized payment models that are consistent with existing payment structures.
Cost of technology
Hospital-at-home programs rely heavily on technology to monitor patients remotely and communicate with healthcare providers. The cost of this technology can be a barrier for some hospitals. To overcome this barrier, hospitals can explore partnerships with technology companies or leasing arrangements that can help to spread the cost of the technology over time.
Limited eligibility criteria
Some payers may have restrictive eligibility criteria for the hospital-at-home services, which can limit the number of patients who can access these programs. To address this barrier, hospitals can work with payers to develop more flexible eligibility criteria that are based on clinical needs rather than arbitrary factors.
Overcoming the challenges
Hospital-at-home programs have been more widely adopted in some countries with single-payer systems, such as Canada and the UK, compared to the United States. There are several reasons for this, including:
Funding and reimbursement
Single-payer systems generally provide more predictable and stable funding and reimbursement for healthcare services, including HAH programs. This can make it easier for hospitals to invest in and sustain HAH programs over time.
Emphasis on primary care
Countries with single-payer systems tend to have a stronger emphasis on primary care, which can help to prevent unnecessary hospitalizations and promote the use of alternative care models such as HAH programs.
Countries with single-payer systems may have more supportive regulatory environments for HAH programs, including regulations that allow for remote monitoring and reimbursement for virtual visits.
While the adoption of HAH programs may be more challenging in a fragmented healthcare system like the US, there are still examples of successful HAH programs in the US. Some healthcare systems and payers have implemented HAH programs with positive results, and there is growing interest in HAH programs as a way to improve patient outcomes and reduce healthcare costs.
Ultimately, the success of HAH programs depends on a range of factors, including funding and reimbursement, regulatory environment, cultural factors, and the ability of healthcare providers to deliver high-quality care in the home setting. If one looks at the bigger picture, home care of critically ill patients can help resolve complex scenarios and avoid readmissions, thereby reducing the cost burden on the healthcare system.