Mayo Clinic has partnered with Medically Home to launch a hospital-at-home model that they plan to scale across the country.
The Rochester, Minn.-based health system has built on Boston-based Medically Home's technology and network of in-home services, and paired it with its clinical expertise and integrated model. The aim is to deliver more affordable and efficient high-acuity care to patients typically bound to the hospital for infusions, skilled nursing, lab and imaging work, and behavioral counseling, among other services. They plan to partner with community organizations and regional suppliers to round out their staffing and supply chain needs, some of which are as basic as reliable WiFi connections needed to relay vital signs.
Over the short term, moving patients from the hospital to their homes will free up space for COVID-19 and other intensive care cases as well as ease the burden on long-term care providers, said Dr. John Halamka, an emergency medicine physician and president of Mayo Clinic Platform, which oversees a range of ventures involving artificial intelligence, language processing and connected healthcare devices. Over the long term, a widely adopted hospital-at-home model could significantly lower costs and boost quality, he said.
"A lot of the early scale will be where there's demand to decant non-COVID patients to home settings to free up ventilators and hospital space for COVID patients," he said. "Next, we'll look to forward-thinking organizations who believe like we do in that care should be more convenient and accessible."
Mayo will test out the advanced care at home model in Jacksonville, Fla. and Eau Claire, Wis. in July and August. It will initially focus on comorbid patients with congestive heart failure, chronic pulmonary disease, urinary-tract infections and other ailments, but could eventually expand to more complex treatment like dialysis as the model develops, executives said.
"The clinical and business models of hospitals are not financially sustainable if they can't achieve the core mission, which is to achieve a clinically stable endpoint for the patient. The heavy use of skilled-nursing facilities and readmissions show that model doesn't work," said Raphael Rakowski, executive chairman of Medically Home. "When you look at the $1.2 trillion sector, it is just a matter of time until pressure to change comes from multiple sources."
The global pandemic is certainly accelerating that change as providers embrace virtual care, look to reduce costs and restore access as they cope with losing their biggest fee-for-service revenue generators. But the move toward consumerism, lowering out-of-pocket costs and alternative payment models had set the industry in motion prior, albeit slowly.
Around 30% of patients will eventually be discharged from the hospital to their home, Rakowski estimated, adding that shifting high-acuity care to the home is an emerging priority for hospital executives.
"I am on about five calls a day with hospitals these days," he said. "In the early days, I was on about five calls a year."
Whether hospital-at-home models take hold more broadly will likely hinge on reimbursement and cost, in addition to buy-in from physicians. While reimbursement for virtual and remote care typically hasn't come close to in-person care, temporary waivers have changed that dynamic, which Halamka expects to become a more permanent fixture.
"With everyone I talk to at CMS and HHS, there's a notion that care at a distance is not going to be rolled back. There's a consensus across the government, academia and the industry that this is where it is going to stay," he said.
The move to capitation, bundled payments and other alternative payment models also rewards a model that is roughly 30% less expensive, yields higher patient satisfaction and better results, Halamka said, with the caveat that things are murkier in fee-for-service medicine.
"Do I think EDs are going to go away? No because people are still going to get in car accidents and have heart attacks and complex surgeries," he said. "But really a decade from now, how many ward beds do you really need? I view the hospital of 2030 as an enormous ED with operating rooms and ICU rooms built on top."
While there is a lot of energy behind alternative sites of care, the business model often falls short, said Dr. Jay LaBine, chief medical officer at naviHealth.
"While I'm bullish on the hospital-at-home model, there isn't as much reimbursement there," he said, noting the lack of facility fees.
But the reimbursement model has to change, Rakowski said, noting that healthcare consumes about 18% of the nation's gross domestic product.
"We're at a tipping point. These inflexible assets are not sustainable," he said.