Hospitals at home: Myth or reality?

Hospitals-at-Home (HaH) aims to provide institution-level healthcare to patients in the comfort of their own homes. This approach is often used for people who need ongoing or specialized medical attention but can benefit from a familiar environment —promoting efficiency and reducing long-term costs associated with care. While this model has existed for decades, it experienced a surge in popularity during the COVID-19 pandemic due to the heightened rate of hospitalizations, which resulted in infrastructure shortages and overcrowding.

Traditionally, medical specialties such as respiratory care, laboratory or radiology services, physical/occupational/speech therapy, pharmaceutical services, medical social services and care from home health aides have been part of HaH. The HaH model is accelerating focus in various care situations, such as urgent care, post-acute care, chronic care management, palliative care, home monitoring and telehealth services. HaH can completely transform patient outcomes by reducing risk and healthcare costs, improving quality of life, relieving the pain and suffering of patients and their families, executing early-stage interventions and improving access to care for patients who are disabled, aged or live in remote areas. As an additional benefit, it also frees up hospital beds for more urgent and trauma cases. According to InsightAce Analytic, the HaH market size is valued at $6.06 billion in 2022 and is predicted to reach $357.62 billion by 2031.

By overcoming the challenges and embracing the opportunities of technological innovation, Hospitals-at-Home (HaH) programs can revolutionize the future of healthcare.

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HaH experiences across the globe

Mount Sinai Hospital in New York City launched a HaH program that provides care to patients with various conditions, including congestive heart failure and chronic obstructive pulmonary disease (COPD). Their research showed that patients who receive HaH care have fewer complications and readmissions.

The NHS in England has been piloting a HaH program for a few years. The program has been successful in reducing hospital admissions and improving patient outcomes. A study of the program in the West Midlands found that it reduced hospital admissions by 30% and the average length of stay by two days.

A study published in the Journal of General Internal Medicine found that HaH programs reduce hospitalization costs and readmissions, leading several Australian hospitals to implement HaH programs. The Royal Melbourne Hospital in Australia has successfully reduced hospital admissions and improved patient outcomes with its own program, the Hospital Admission Risk Program (HARP).

The National Healthcare Group (NHG) in Singapore has been operating an HaH program since 2017. The program has been successful in reducing hospital admissions and improving patient satisfaction. For example, one study found that it reduced hospital admissions by 20% and improved patient satisfaction scores by 10%.

Building blocks

There are five pivotal components of HaH technology:

1. Admission avoidance: This component prevents unnecessary hospital admissions by providing appropriate care and medical interventions in a patient's home environment. It is especially relevant for individuals with acute conditions or exacerbations of chronic illnesses who, under traditional care models, might be admitted to the hospital. Through admission avoidance, patients receive comprehensive medical care —including diagnostic evaluations, monitoring and treatment —in their homes. By effectively managing patients in their residences, healthcare providers can reduce the burden on hospital resources, minimize healthcare costs and avoid the potential risks of hospital-acquired infections.
2. Early supported discharge: This component aims to transition patients from the hospital to their homes as soon as medically appropriate. Rather than keeping patients in the hospital for extended periods, early supported discharge ensures they receive continued care and support in their home environment. This is particularly valuable for patients who have already received initial hospital-based treatments and can safely continue their recovery at home. It includes ongoing medical supervision, rehabilitation services and assistance with activities of daily living to promote faster recuperation while maintaining the patient's quality of life.
3. Enabling ecosystems: Medical devices, software, cloud, telemedicine, supply chain and remote patient monitoring make HaH more efficient, safer and scalable. Advancements in healthcare technology like sensor technology, miniaturization and machine learning allow for real-time remote monitoring of physiological parameters. For example, breakthroughs like pocket ultrasound devices, portable MRI machines, non-invasive blood chemistry assessment, multiparametric cardiopulmonary testing and even smart toilet seats that can help monitor congestive heart failure patients are making it possible to provide high-quality care in the comfort of a patient’s home. Telemedicine is another key healthcare technology service that enables doctors and nurses to remotely monitor patients’ conditions, communicate with them in real-time and provide timely interventions when needed. This not only improves patient outcomes but also reduces the need for hospital readmissions. Applied AI is another integral part of HaH technology. Analyzing clinical data captured by devices and making it relevant for a healthcare professional is one such application.
4. Patient experience: Patient experience while using HaH is a key determinant of its acceptability. It is an appropriate way to determine whether the service is feasible in the long term. According to a National Institutes of Health article on satisfaction with HaH, a higher proportion of patients were satisfied with treatment in HaH than with the acute care provided at the hospital. They experienced greater comfort and convenience of care. Family members of patients treated in HaH were also more likely to be satisfied with multiple care domains.
5. Reimbursement landscape: Securing adequate reimbursement from payers — including government programs like Medicare and Medicaid, as well as private insurers — is a critical concern. Currently, only limited coverage for HaH services exists. The reimbursement rates offered will need further refinement to accurately reflect the actual value and cost-effectiveness of HaH care. Most studies report that HaH results in significant cost-savings compared to inpatient-hospital care, but there is a risk of overestimating these savings based on the inclusion of less severe patients in the intervention group than the control group. Further, inaccurately high unit costs for hospital stays may result from averaging costs across patients with different disease severity or all the days of the hospital stay.

Outlook

While a promising model, HaH certainly doesn’t come without challenges. These programs must navigate a complex regulatory landscape, adhering to various federal and state regulations related to licensing, accreditation, quality assurance and safety standards.

HaH programs also deal with clinical and operational complexity. Providing care at the same level as traditional hospital settings requires access to advanced medical equipment, a highly skilled and adaptable healthcare workforce, reliable transportation for home visits and effective communication tools. HaH programs must effectively coordinate care across various settings and providers, including primary care physicians, specialists, home health agencies and pharmacies. To achieve this, robust protocols and workflows are essential for managing patient eligibility, enrollment, discharge and follow-up.

Further, patient and provider acceptance is a challenge. Encouraging patients and their caregivers to embrace HaH care and understand its benefits and expectations is crucial. Some patients may prefer the security of a hospital environment or lack suitable conditions at home for HaH care.

Leveraging technology is vital for these programs, enabling remote monitoring, telehealth consultations, data analytics and clinical decision support. However, technology integration can present hurdles such as interoperability issues, security concerns, privacy considerations, usability challenges and the need for reliability.

Technology can play a significant role in addressing the challenges and improving the implementation of HaH programs. For instance, it can streamline regulatory and reimbursement processes, simplify clinical and operational workflows and increase satisfaction for patients and providers. It can also provide the data needed to analyze and improve a program's effectiveness. By automating tasks, enhancing coordination and optimizing resource allocation, technology can support more efficient and effective HaH care, ultimately improving health outcomes and reducing costs.

Examples include:

1. Wearable devices or remote monitoring systems allow patients to receive the same care they would receive in a hospital setting
2. Point-of-care diagnostics that can perform tests such as blood chemistry, urine analysis or ultrasound at home
3. Virtual reality or augmented reality that can provide immersive education or entertainment for patients at home
4. AI and machine learning can provide personalized guidance and recommendations for patients and providers based on their data

Technology can be a powerful enabler of better care delivery and outcomes. By overcoming the challenges and embracing technological innovation opportunities, HaH programs can revolutionize the future of healthcare.