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Blog • • 5 minute read

The Doctor Is In — Your House

From acute care at home to a hospital at home — a 100-year pandemic, swiftly growing Medicare population, shortage of clinicians, changing patient expectations and a focus on quality over quantity are changing where and how care is delivered.

"Home is where you feel at home and are treated well." – Dalai Lama

It has been my experience that humans have a tendency to forget, or better, subconsciously repress adversity in exchange for a hopeful tomorrow, reminding me of The Who's classic Eminence Front. However, as we move forward into 2022 and recall the resourcefully disruptive innovation that for many required faith, we realize we accomplished some remarkable things in a short time. 

Virtual care was one of those stories that won't be hiding. Before the pandemic, organizations like Mass General Brigham planned to have approximately 12,000 remote visits in 2020. By October 2020, they were at 1.4 million visits remotely. In 2021, they had more than 2 million.

Because the pandemic overwhelmed hospital and staff capacities, patients who otherwise met clinical criteria for hospital care also started receiving virtual care with remote patient monitoring (RPM) IoT medical devices, like SpO2 monitors, blood pressure cuffs, scales, thermometers and even AI-enabled symptom checkers. Aside from the empowering technology and necessity, the rapid growth of virtual care was also fueled by the relaxation of clinical licensure across state lines and policies to support reimbursement for telehealth encounters. As a result, the art of the possible became a reality as five-year strategic plans for digital health were being executed in weeks — scaling healthcare beyond the confines of traditional hospital hallways.

In 2020, CMS established the Hospital Without Walls and Acute Hospital Care at Home programs. The latter made it possible for hospitals to treat eligible patients where they would like to be most: at home. As of early February 2022, 201 hospitals across 91 healthcare systems in 34 states have been approved for this program. One recent addition to this CMS initiative is JFK University Medical Center, part of Hackensack Meridian Health. This New Jersey hospital will be monitoring eligible chronic disease Medicare patients remotely using IoT medical devices measuring blood pressure, blood oxygen, temperature and weight for early recognition of decompensation, promoting early intervention. Also, home health nurses visiting patients can bring medications, infusions, rehabilitation and other patient care needs.

Many non-clinical variables significantly impact patient health and outcomes. It has been shown that 80 to 90 percent of modifiable contributors to health outcomes stem from the social determinates of health (SDoH). These include access to quality healthcare and education, social and community support, economic stability, and one's neighborhood and environment. For example, access to quality care alone is denied to 3.6 million Americans each year because of transportation issues. Factoring SDoH into hospital-at-home programs can help drive healthcare equality. In addition, having a better understanding of the conditions in which patients live day-to-day allows organizations to assist them with things like nutritious meals, coordinating social and community support, environmental awareness and other hard truths that humans face.

A poll done by Morning Consult in August 2021 identified that out of 2,200 adults, 85 percent supported the Choose Home Care Act, a bipartisan Senate bill proposed to expand Medicare beneficiaries' access to home health care after hospitalization. 68 percent of adults felt that post-hospitalization care was best delivered at home versus at a skilled nursing facility. 90 percent said it was essential for them to have the ability to choose the setting in which they or a loved one recovered after hospital discharge.

Patients are not the only ones who support care delivery at home. For example, healthcare systems like Penn State Health, Jefferson Health and UC Irvine Health have also recently partnered with technology vendors such as Contessa, BAYADA, and DispatchHealth to roll out their unique hospital-at-home services. Others are investing in hospital-at-home technology platforms and services. For example, Kaiser Permanente and Mayo Clinic have partnered with Medically Home, together putting $100M in the pot. Payers are putting skin in the game as well: UnitedHealthcare implemented a maternal RPM program in Tennessee to better monitor expecting mothers. Also, Humana has partnered with St. Louis-based healthcare provider Mercy to manage virtual care for Medicare Advantage patients in Arkansas, Kansas, Missouri and Oklahoma via Mercy's hospital without beds program run by Mercy Virtual. WWT and Cisco helped build the Mercy Virtual Care Center that has been so successful along this transformational paradigm.

So why are payers, providers and patients supporting this? Because by 2030, the Association of American Colleges predicts the U.S. will have a shortage of 120,000 physicians, and the CDC projects that the over- 65 population in the U.S. will double (the silver tsunami). And because the technology, data, people and processes must scale to meet this critical demand, reduce the cost of care, positively impact patient outcomes and experience, and align with at-risk contracts and value-based care.

Transactional, episodic care is increasingly becoming the exception and not the rule. A patient does not have congestive heart failure only four times a year when they visit their primary care doctor or cardiologist. Instead, they live with it daily and need to be proactively monitored to ensure they have the support and guidance to be healthy every day.