Modern Healthcare spoke with four CEOs from the hospital, technology, hospital-at-home and insurance sectors about the hurdles they faced in 2023 and their predictions for the upcoming year.
Rami Karjian, co-founder and CEO of Medically Home, understood the possibilities of leveraging technology to deliver hospital-level care outside facilities when he helped launch the Boston-based company nearly a decade ago. His vision was realized in part during the COVID-19 pandemic, when the Centers for Medicare and Medicaid Services granted waivers to hospitals allowing them to care for some patients at home to alleviate overcrowding.
Medically Home provides hospital systems, including Kaiser Permanente, the Mayo Clinic and UNC Health, with a technology platform that includes telehealth and remote patient monitoring.
Karjian talked about the challenges of advancing hospital-at-home and offered his predictions for its future. The interview has been edited for length and clarity.
What are the biggest challenges organizations in the hospital-at-home space faced in 2023?
This year we saw a lot of brick-and-mortar hospitals facing increased capacity issues, as we started to see more volume come in post-COVID-19 and a workforce that still hasn’t fully recovered from all of the trauma of the pandemic. So we have been focused on creating additional capacity for these health systems in a way that feels easy to them and allows their nurses and doctors to practice the care in an environment that isn’t as [restrictive] as working in a brick-and-mortar hospital, allowing them to connect differently with the right patients in this model.
Related: Why home is becoming the future for hospitals
The CMS waiver program for hospital-at-home is set to sunset at the end of 2024. Do you think it will be extended or made permanent, and how are you preparing?
There are more than 300 hospitals operating under the waiver. Hospitals are expecting that CMS will either extend it so the agency can study [the model] a little bit more or make the waiver permanent. We are strengthening our logistics going into the home; we are strengthening the software that powers the logistics; and we are continuing to see many health systems come to us and ask us to start this up for them because of the capacity and the care challenges they are having.
How has the technology for hospital-at-home evolved over the past few years?
We are seeing two trends: a move from active to passive and a move from intermittent to continuous.
Instead of a blood pressure [device] that is intermittent—"I take my blood pressure four times a day"—now the technology for patches and wearables allows for more frequent monitoring. That is more convenient for the patient and easier for the clinician. In more passive technologies, the technology is able to reach out to [the patient], as opposed to [the patient] triggering it. So, we’re asking less of patients and making the technology more accessible for them.
What are you seeing in terms of staffing trends?
It is improving. There is a massive clinician shortage at every level. But we are taking clinicians who don’t normally provide hospital-level care and we’re allowing them to expand their capabilities. My favorite example is paramedics. When you call 911, a paramedic comes into your home and stabilizes you and transports you to the hospital. With this decentralized model, we are able to have the paramedic stay in the home, start hospital-level care and have the patient stay in their home.
What hurdles are rural hospitals in particular facing with regard to the hospital-at-home model?
We need to see more rural hospitals embrace this decentralized care model because it solves a real access and equity issue.
If you are a rural, critical access hospital and you have a census of two or three patients and you are staffed up and licensed for 25 beds, there is a mismatch between staffing and patients that they are getting. That causes a lot of problems they probably want to address before they start adding capacity into the community [with acute care in the home].
What advice do you have for providers looking to get into hospital-at-home?
My big message is, "Now is the time." We have seen a shift from "Should I get into this?" to "How and when can we start?"
The capacity issues we have as a country, the clinician shortages we have as a country aren’t going to get better. They are going to get worse. [Hospital-at-home] allows you to address that. And the sooner, the better.
