Have Hospital-at-Home Programs Finally Come of Age?

Hospital-at-home programs have existed for more than 20 years. But only recently have they started to build momentum. The COVID-19 pandemic has significantly accelerated interest in developing and expanding hospital-at-home programs, and with new payment support from CMS, these programs can be expected to proliferate in coming months and years. For those health systems with their own health plans and/or with a significant enrollment in accountable care organizations (ACOs) that are taking significant financial risk, a hospital-at-home program can offer the potential to improve care and reduce costs for a segment of the patient population.

Today’s growing interest in hospital-at-home programs is a reversal of the trend that preceded COVID-19. Despite evaluations showing the effectiveness of such programs, adoption was slow due to a number of factors:

• Physician concerns about patient safety
• Patient lack of confidence in receiving some of their care through telehealth
• Reluctance of payers, especially fee-for-service Medicare, to pay providers appropriately for delivering acute services in a home setting

Despite these barriers, a number of health systems have developed their own hospital-at-home programs. Meanwhile, a number of for-profit market disruptors have developed their own programs, sometimes in partnership with health systems. Examples include Medically Home, Amedisys, Contessa Health and Envision Healthcare. (See the sidebar below for health system examples of hospital-at-home programs).