How tech companies are working to expand hospital-at-home

Technology companies are rolling out new services to health systems as enticements to launch hospital-at-home programs.

Medically Home, Vivalink and Inbound Health are looking to make it easier for health systems to staff, monitor and manage patients getting hospital-level care at home through the Centers for Medicare and Medicaid Services' Acute Hospital Care at Home waiver. More than 370 health systems have applied for the waiver over the past four years. However, some have not yet launched hospital-at-home programs in part because of cost, staffing shortages and logistical problems, among other challenges. Some may also be waiting to see if Congress will extend the waiver, which is set to expire at the end of December.

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Starting and maintaining hospital-at-home programs can be an expensive undertaking for many health systems. CMS requires providers set up command centers staffed by physicians and nurses who make virtual daily visits to patients and are on call around-the-clock in case patients' conditions worsen. Nurses must also make onsite visits twice a day.

"It does take time to launch it right, with all the pieces in place for it to be successful," said Dawn Jacobson, senior vice president for home care at Hackensack Meridian Health, which launched its hospital-at-home program at three medical centers in April.

Technology companies are looking to cut down on that time — and expense — so more systems can get fledgling programs off the ground.

Boston-based Medically Home is expanding the support services it offers health systems for hospital-at-home. The company has offered remote patient monitoring equipment, advisory and logistical services, as well as clinical staff for in-home visits to approximately 20 health systems nationwide.

But it did not staff command centers for health system partners until recently. Medically Home announced a new partnership with Atlanta-based SCP Health last month to staff physicians and nurses at a command center in Dallas that health system partners can use if they don’t want to establish their own hub.

Medically Home CEO Graham Barnes said using the command center would be an additional cost for health systems, but it could be more economical than providing their own staff.

“This is something that they can turn on right away and it’s purely sort of an incremental, bearable cost,” Barnes said.

He did not provide additional details on the cost for systems to access the command center.

Medically Home began a soft rollout of the SCP command center with Hackensack Meridian Health.

“Implementing the hospital-from-home program would have been difficult if we had to create and staff our own command center,” said Jacobson. “It would have also taken longer to implement the program from the time we entered into a contractual relationship with Medically Home, as well.”

Investing in remote patient monitoring equipment required under the waiver can also be a heavy lift for health systems that choose to launch home-based hospital programs. The equipment is used to monitor patient vitals 24/7.

Digital healthcare solutions company Vivalink last month launched a no-cost pilot program to let nonprofit health systems test remote patient monitoring equipment. The Campbell, California-based company will also provide training and support free-of-charge to help hospital staff familiarize themselves with the technology.

Vivalink CEO Jiang Li said health systems can try the equipment for a few months. He said doctors and nurses need to understand how to properly monitor acutely ill patients, even if they already have experience using technology that monitors patients with chronic illnesses.

“Hospital-at-home patients require much more intense monitoring from the technology and vital monitoring point-of-view, as well as a much faster response time,” Li said. “From the physicians' side, triaging patients has to be much faster. That part is totally different from the standard remote patient monitoring.”

Li said three health systems have contacted Vivalink about testing the equipment, with one planning to begin piloting it early next year.

Another challenge is getting some acutely ill patients comfortable with the idea of receiving hospital-level care at home, rather than in a facility. Inbound Health introduced an app last summer that could help ease patients' concerns.

Minneapolis-based Inbound Health provides technology and management services for hospital-at-home programs. The app lets home-based hospital patients contact clinical teams directly, keep track of their own vital signs alongside clinicians and stay advised of when care teams will make in-home visits.

“Prior to the development of the app, patients and caregivers relied on manual and time-consuming processes throughout the care episode,” Inbound Health CEO Dave Kerwar said in a news release.

The app builds on a patient management program Inbound rolled out last year that helps health systems identify patients eligible for hospital-at-home and supervise their care. About 400 patients have used the app so far, said an Inbound Health spokesperson.

Inbound provides hospital-at-home services to Minneapolis-based Allina Health and St. Louis, Missouri-based SSM Health. The company will expand services to two more health systems in 2025, the spokesperson said.

With a variety of programs vying for health systems' dollars, Barnes said it is imperative that technology companies develop innovative ways to move home-based care programs to the top of provider priority lists.

"This is a way to make [hospital-at-home] easier to stand up and easier to justify," Barnes added.