Hospital at Home (HaH) enables the provision of acute care in patients’ homes. John Hopkins Health Care Solutions (JHHCS) developed the model in 1995 to improve outcomes, reduce healthcare costs, and enhance patient experiences by providing hospital-level care to acutely ill older adults at home. Since 2002, JHHCS has supported nine sites to implement HaH. Based on the HaH model, the Centers for Medicare & Medicaid (CMS) developed the Medicare Fee-for-Service Acute Hospital Care at Home (AHCaH) reimbursement model in 2014.

Impact of PHE on Acute Hospital Care at Home Initiative

During the COVID-19 public health emergency (PHE), CMS expanded the use of the AHCaH. In November 2020, CMS waived the 24-hour on-site nursing requirement, enabling hospitals participating in Medicare to ease inpatient capacity constraints and reduce patient exposure to infectious diseases by providing acute care to patients at home. (Note: In January 2021, the Veterans Health Administration issued guidance for Veterans Administration medical centers to implement similar services for veterans). While some PHE-related waivers are set to expire when the PHE ends on May 11, 2023, the Consolidated Appropriations Act of 2023 extends funding for the AHCaH initiative through the end of 2024.

*See VHA Directive 1144
ED: Emergency Department; HiH: Hospital in Home; STACH: Short-Term Acute Care Hospital; VAMC: VA Medical Center; PAC: Post-Acute Care; LTCH: Long-Term Care Hospital; IRF: Inpatient Rehabilitation Facility; SNF: Skilled Nursing Facility; VHA: Veterans Health Administration.

Digital Health Tools for Facilitating HaH Care

Digital health technologies (DHTs) provide a variety of tools for facilitating HaH care, including remote monitoring, as Avalere discussed in a prior RPM insight. Under the AHCaH program, CMS requires “a minimum of two sets of in-person vital signs daily and remote monitoring consistent with existing hospital policies and standards of care.” Depending on an individual patient’s care plan, CMS may allow recognized paramedics or registered nurses to conduct one or both visits remotely. To conduct these visits remotely, providers leverage assistive technologies including remote monitoring devices. For example, Actigraphy and accelerometer sensors monitor patient movements and vital signs. Prescription or over-the-counter oximeters capture heart rate and blood oxygen levels relevant to conditions like COVID-19 or chronic obstructive pulmonary disease.

Either remotely or on-site in a patient’s home, these interoperable solutions for inpatient-level care offer real-time data to support diagnostics and treatment and possibly offer providers clinical decision support (CDS) functionality. In September 2022, the Food and Drug Administration issued guidance “clarifying the types of CDS software functions that are excluded from the definition of device.” Patient data from remote monitoring devices can be incorporated into electronic health record (EHR) systems through interfaces or integrated software applications, extending the meaningful use of the patient’s data.

Expanding HaH Using Digital Health Technologies and Devices

Opportunities to leverage DHTs to expand patient access to acute hospital-level care at home are available. DHTs can help reach patients through new channels, improve both provider and patient experiences, and capture real-world data (RWD) for individual patients, populations, and providers. RWD can then be leveraged to generate valuable real-world evidence (RWE) to evaluate patient outcomes. With access to more data, health IT and digital health companies are investing in clinical, claims, and related data assets (e.g., EHRs). With the increased availability of RWD and demand for RWE, larger technology companies are acquiring or partnering with major EHR vendors to apply digital and analytics solutions to healthcare use cases. A range of stakeholders are becoming more interested in embedding artificial intelligence and machine learning models (e.g., large language model chatbots) within DHT and health IT solutions.

Avalere Outlook

Advancing technologies and the HaH model provide an opportunity to expand patient-centered care and improve patient outcomes and population health. Research shows comparable or improved patient outcomes when acute care is delivered at home rather than an inpatient setting (whether in the AHCaH program in the US or in similar programs abroad).

As patients, providers, and payers take interest in the HaH experience, Avalere’s access to Medicare and Medicare Advantage claims data enables us to measure uptake of the AHCaH program. Based on a strong understanding of key payers, providers, and patient populations, we advise manufacturers and DHT companies on coverage, coding, and payment relevant to commercializing products and reimbursable services. To learn how Avalere can help you define viable market access strategies to deliver acute care to patients at home, connect with us.