Inpatient hospital care in the comfort of home
BCBS ProgressHealth, By Travis Messina, December 2019
- Every day, in emergency departments and urgent care centers across the country, thousands of patients are assessed for acute illnesses such as asthma, congestive heart failure, pneumonia and urinary tract infections. If symptoms are severe enough, the patient is admitted to the hospital for what is often an expensive and uncomfortable inpatient stay. Even worse, these stays may lead to an increased risk for dangerous infections or complications.
Today, however, a growing number of health systems are adopting a better way to deliver hospital care. The trend is called Home Recovery Care (HRC), a model in which patients receive all the essential elements of an inpatient stay at home.
Benefits for patients include all the comforts of home: sleeping in their own bed (without constant disruptions), eating their own food, setting the thermostat and moving around in a familiar environment among family, friends and pets. For clinicians and insurers, HRC represents a more affordable way to provide coordinated, high-quality care with higher patient satisfaction and lower risk of infections that can cause readmissions.
How does Home Recovery Care work?
If a patient is eligible for inpatient care, but is not critically ill, and meets several other criteria, including meeting the needs described in a home and health assessment, they have the option to choose HRC.
Once the patient has opted in, he or she is assigned a care team, which includes an acute care registered nurse, who cares for the patient under a physician-devised care plan while in the home; a hospitalist, who makes visiting rounds through virtual technology; and a Recovery Care Coordinator, also a registered nurse, who coordinates the patient’s care and monitors progress for 30 days. Any equipment needed for acute care, such as an IV, oxygen and pulse oximeter, is delivered to the patient’s home.
The care team is available to the patient 24/7. After the first few days, the patient continues to have daily access to the Recovery Care Coordinator, who will make follow-up appointments with the patient’s primary care physician and other physicians, and ensure they are complying with their physician-directed instructions. From there, the Recovery Care Coordinators identify gaps in care and, consistent with research, address them within seven days with the patient’s primary care physician.
Why Home Recovery Care continues to expand
Prominent systems across the country, including CommonSpirit Health, Ascension Saint Thomas, Prisma Health, Allegheny Health Network, Marshfield Clinic Health System and Mount Sinai Health System, are integrating this more comfortable and convenient model into their initiatives to transform care. And they’re realizing big results:
The Marshfield Clinic has reported a 44 percent decrease in readmissions to go with a greater than 90 percent patient satisfaction.
Last year, Mount Sinai Health System reported in the Journal of American Medicine that patients enrolled in their hospitalization-at-home model had shorter stays, lower readmission rates and fewer emergency department visits than those who were admitted for inpatient care.
Several factors explain this success. The 30-day monitoring, 24/7 access, and consistent follow-up with the patient are known to drive positive clinical results. Lower costs are another benefit of HRC-type models, which are operated through a risk-based arrangement rather than fee-for-service. For example, Contessa enters into a joint venture with each health system, those joint ventures hold contracts with numerous health plans whereby the joint venture takes episodic risk, meaning if the episode is in excess of the contracted rate we are liable.
Until now, a difficult reimbursement landscape has been the biggest barrier to adoption, but more systems are taking advantage of government grants that provide incentives for patient-centered care. And more insurance companies, including Highmark Blue Cross Blue Shield, are covering HRC at select hospitals for patients with both commercial and Medicare Advantage plans.
As the drive towards a more patient-friendly and value-based health system accelerates, HRC is likely to continue its trajectory toward becoming a lynchpin of future models of care. The benefits for everyone involved – increased comfort and better outcomes for patients, lower cost and more efficient allocation of resources for clinicians – make it an approach to care delivery that cannot be ignored.
Contessa Home Recovery Care is funded in part by BlueCross BlueShield Venture Partners, L.P., a corporate venture fund licensed by the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. The fund invests in promising emerging companies of strategic relevance to Blue Cross and Blue Shield Plans. These companies are bringing creative, cutting-edge solutions to the healthcare marketplace.
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