Has the Time Finally Come for Hospital at Home?

Concerns about possible surges of COVID-19 patients, combined with the spread of value-based payment and companies offering technology and operational support, have prompted some health systems and health plans to take a second look at the hospital-at-home model.

Long before fears of infection from the coronavirus made people wary, hospitals were often not the best place to be treated and recover. Awareness of the risks of infections and the debilitating impacts of hospital stays, particularly on patients who are frail, have cognitive impairments, or other vulnerabilities, prompted Bruce Leff, M.D., a geriatrician and health services researcher at Johns Hopkins University, to establish the first hospital-at-home program in the United States 20 years ago.

The model, which offers people who would typically require hospitalization to treat problems such as acute pneumonia, dehydration, or exacerbations of conditions like heart failure or chronic obstructive pulmonary disease (COPD) the option of receiving acute-level care in their homes, has been one of the most studied health care delivery reforms.

In recent years, a handful of U.S. health systems have launched similar programs, either because their hospitals are operating at capacity and/or they’ve taken on financial risk for the total costs of patients’ care and thus benefit from delivering services in a lower-cost setting. The Veterans Health Administration, which controls both payment and care delivery, has funded its own hospital-at-home program, as have some health systems that have their own health plans and/or substantial numbers of patients in accountable care organizations or managed care plans.