By Eric Wicklund
UMass Memorial Health is joining the Hospital at Home movement, with a new programme that integrates remote patient monitoring and telehealth strategies with in-person visits to provide care management at home for patients who would otherwise be taking up a hospital bed.
The Worcester-based health system is partnering with Current Health on the programme, which will likely start in August with five carefully-selected patients but could grow to as many as 50 within a year, says Dr. Eric Alper who’s leading the project. The idea is to create a virtual care environment that enables these patients to get the same care at home that they’d get in the hospital.
“We are so wedded to the idea of having these patients inside the four walls of the hospital,” he says, that it’s taken a while to think outside the box – literally, in this case.
Stoked in large part by the challenges faced by health systems during the coronavirus pandemic, the Hospital at Home concept is rapidly gaining traction across the country. Advocates say the programs reduce stress on the hospital, filter out unnecessary expenses tied to inpatient care and result in improved clinical outcomes and higher patient satisfaction.
Hundreds of health systems are participating in the Centers for Medicare & Medicaid Services’ Acute Hospital Care at Home Programme, a payment model launched in November 2020 to help reduce stress on hospital infrastructure caused by COVID-19.
Alper, who’s UMass Memorial’s chief quality officer and chief clinical informatics officer, says the health system was struggling under the weight of the pandemic.
“One of the challenges to UMass is we’re constantly full,” he says. “Our census is almost always 100 percent, (and) we were often forced to refuse transfers from other hospitals. We had to find some way to ease that pressure.”
UMass Memorial built a field hospital to handle the COVID-19 overflow. That spurred administrators to start thinking about other ways they could extend care.
“Our team’s ability to quickly build out a field hospital to care for patients during the height of the pandemic has inspired us to think differently about how we can deliver care outside our hospital walls,” the health system’s president and CEO, Dr. Eric Dickson said in a June press release announcing the Hospital at Home programme. “We see an opportunity to pioneer a new care delivery model that not only addresses hospital resource constraints, but also enables more preventive care and improved patient experiences and outcomes at scale.”
Since then, Alpert and his team have been laying the groundwork for a planned August launch. This includes identifying the right type of patient for the programme and developing a list of all relevant diagnosis related groups (DRGs).
It also includes drafting a list of exclusion criteria. For now, Alpert says, that includes patient mobility issues, problems with the home environment and a lack of familiarity with telemedicine technology. (The right home environment is an important factor in supporting a programme in its early stages, and one that health systems can address with more resources later, when a programme is sustainable.)
Alpert says the complexity of the programme surprised him at first.
“It’s been a big project,” he says. “We all know how to take care of a patient in the hospital … but there are lots of little things to take into account – even outside the technology – when you take that care outside the hospital.”
Getting staff to buy into the program and become engaged is a priority, he says. To that end, the health system brought a nurse leader with experience in the “hospitals outside hospitals” concept to serve as vice president for the program. Physicians and nurses, emergency department staff, and those in the IT and finance departments all need to be on the same page and ready to support the program.
That programme will begin in the ED, where patients will be screened and, if approved, meet with care providers and be given mHealth devices. Then they’ll go back home, where they’ll be visited by a nurse at least twice a day and monitored by the hospital through the devices and a telehealth platform. A physician will meet with the patient each day via virtual visit, and paramedics will be on standby in case of emergency.
The programme will also integrate with the health system’s Epic electronic health record.
“We really want these patients to be treated like any patient in our hospital,” Alpert says.
Success will be measured in how patient respond to treatment at home, average costs for care at home compared to inpatient costs, patient satisfaction and the number of adverse events and transfers – either back to the hospital or to another facility – avoided. What can’t be measured, Alpert says, is the elimination of stress around patients and their families, reduced chances of hospital-acquired infections, and the feelings around recovering at home rather than in a hospital.
That’s offset by the costs of launching the programme, including staffing, technology and EHR integration.
“But we feel like this is a very strategic investment for us,” he says. “This window into the patient’s home will give us new insights into care.”
The programme hasn’t even launched yet, and Alpert already sees room to grow. He wants to branch out to other patient populations, such as those recovering from a surgical procedure or hospital stay. And he’d like to see the program add in chronic care management and health and wellness resources.
“I think that there will be a lot of new opportunities,” he says. “We’ve already had people (from other departments at UMass Memorial) who are asking us how to do that.”
