Build or Buy? Three Things to Consider Before Starting a Hospital at Home Program

When talking with health systems, one of the first questions I often hear is, “Why should we partner with Contessa instead of building a hospital care at home program ourselves”? It’s a fair question, and there are many factors to consider.

Developing a hospital care at home program is an organizational shift that comes with a significant set of challenges that require time, resources, and expertise to solve. So, when considering integrating a hospital care at home service line into a health system, is it better to build or buy?

Here are the three key areas I tell healthcare leaders to evaluate thoroughly as they make their decision:


Whether you build or buy, hospital care at home requires a significant commitment of financial and organizational resources. I’ve often seen hospitals try to “go it alone” by simply piling programs, and all they entail, onto the plate of an already-stretched-too-thin senior leader. Policies have to be written and revised. Care teams have to be hired and trained. Substantial amounts of capital and time must be invested in technology, credentialing, education, and more. All of those things have to happen before the first patient is even treated. If your team has the capacity and capability to develop these things successfully, and resources are all that are needed, building a program may be the right choice for your organization.

Alternatively, if establishing and leveraging these resources feels like a stretch, partnering with an organization, like Contessa, may be a better route. Doing so creates savings by allowing you to leverage a team that can accelerate many key components including:

1) Speed to market on operations,

2) Negotiating payer contracts for a program that had never been reimbursed by a payer before 2016,

3) Creating the logistical infrastructure of a virtual hospital, and

4) Structuring a partnership that will help your organization realize the best ROI you need to achieve.

This is what we do every day. The logistics and operations for hospital care at home are drastically different than a health system’s typical core business. That is why we built Contessa: to provide the infrastructure necessary for hospital care at home programs while allowing health systems to focus on their core business.

Clinical Operations.

When delivering hospital care at home, the turnaround time of services, and the quality of those services, needs to mirror the inpatient setting. This is easier said than done, and it requires robust safety protocols, telehealth integration, administrative workflows, and providers who champion the program. Contessa’s success is built on a foundation of these four pillars.

Without a doubt, there is a cultural shift that needs to take place before implementing a hospital care at home program or any other care at home model, and some organizations are better equipped to accomplish that than others. If you think about it, we are asking clinicians to do the exact opposite of what they were trained to do. Clinicians are trained to identify patients who need hospital care and then admit them to the hospital. Now, we are asking them to send patients home. There is quite a bit of muscle memory that has to be broken down. And while sending patients home that require hospital care is a culture shift, the ongoing COVID-19 pandemic is driving providers to ramp up adoption. Partnering with a company like Contessa affords clinicians the opportunity to tap into other program operators across the country and help your clinical staff adapt to this modern care delivery model quicker and more efficiently.


The technological and digital health lens is also an important one to consider when evaluating whether to build or buy. Typically, electronic medical records (EMRs) for a single system are not equipped to manage patients over a wide geography, whereas a hospital care at home program needs to have that capability. Knowing that some systems are further along in the adoption of sophisticated EMRs than others, this can be a key factor in your decision to build or buy.

Mobile and remote medical equipment are also must-haves for hospital care at home and often come at an added cost. Partners entrenched in this work are not only likely to have these tools on-hand but also to have an understanding of their implementation – which is never a fun part of the “build” process.

Partnering bridges some of the technology gaps that may become more obvious as you begin to consider building a hospital care at home program. For example, Contessa utilizes Care Convergence, a proprietary platform that connects patient care with providers and health plans. We have the unique ability to manage patient care and revenue cycle transactions, and report quality metrics and data.

Our care model also comes equipped with remote patient monitoring kits and tablets for virtual hospitalist roundings. While remote patient monitoring is becoming more prevalent, the set-up we establish with our kits for hospital-level care at home embeds unique care plan aspects to ensure patient safety at all times.

The End Game.

A close friend once told me that innovation is the ability to execute at scale. So, if you are considering building your own program, ask yourself: what it would take to deploy hospital-level care across your entire system in concert with all payers? How many people, how much time, and what type of investment would it take to accomplish that? And once you get to that point, how long will it take to refine it to where you are satisfied with the model?

Though I am clearly biased, when you break it down, the benefits of partnering with a company like Contessa rather than starting from scratch are pretty clear. Partnering with an established hospital care at home provider makes a stronger, more sustainable, and financially successful program.

What is more, Contessa’s joint-venture model sweetens the deal. We aren’t just a vendor and health systems don’t simply buy-into our model. We contribute capital alongside our partners to create a new business, a new service line, of which Contessa now offers several. As partners, we build this service line together and, subsequently, split the profits. Our risk-assumption and the proven effectiveness of what we do also means security and a seamless foray into a new care model for those new to the space.

We have heard experts across the field say they have everything they need to execute this service across their own entity, but it doesn’t always pan out the way they envisioned. Much like in life, sometimes there’s just no need to re-create the wheel. And isn’t it easier to pay once and get it right, than to build, fail and ultimately wind-up spending much more to have some help?

Editor’s note: This post has been adapted to reflect the landscape as of December 2021 and reposted to emphasize its timeliness and importance. 

Meet Our Expert

Travis Messina, Founder & Healthcare Executive

Travis founded Contessa in 2015 to provide a new standard of healthcare in the home for providers, payers and patients. Since its launch, the company has partnered with twelve health systems and a major payer and continues to grow as part of Amedisys, Inc. Before Contessa, Travis built his career investing in healthcare ventures. He spent time at Martin Ventures, Vanguard Health Systems, Signal Hill Capital and SunTrust Robinson Humphrey.