Prioritizing Admission to Hospital at Home: A Smarter Pathway for Health Systems and Patients 

As hospital-at-home continues to cement its role in helping health systems achieve high-quality outcomes and address capacity strain, a more complete picture is emerging of how this model most effectively creates benefits for all involved. 

When hospital-at-home is prioritized in the decision-making process for patient admissions, there exists an opportunity to create improved cost savings, reduce challenges in the emergency department, drive higher patient satisfaction and facilitate increased admissions.  

Health systems, administrators and leaders who understand this complex and evolving picture are poised to fundamentally change the way care is delivered. 

The Typical Path to Hospital-at-Home Admission 

Typically, the routine pathway to hospital-at-home admission begins in the emergency department (ED), where patients are admitted to an inpatient unit for continued care. It is while the patient is admitted to the floor that hospital at home often comes into the picture. 

This represents missed opportunities for both patients and the health systems that serve them. A patient who is eligible and appropriate for hospital-at-home admission can be identified and prioritized at multiple stages of their journey, realizing financial and operational benefits for the health system and improving patient satisfaction and outcomes.  

Benefits of a Hospital-at-Home Episode 

In our Recovery Care at Home model, we see a patient satisfaction top box composite that hovers around 90%. This is directly affected by patients’ desire to remain at home — after all, most patients don’t want to be in the hospital at all if they can help it.  

A hospital-at-home episode preserves the patients’ ability to recover in a familiar environment while safely delivering hospital-level care. That episode of care also affects the hospital’s capacity strain in two ways: it decants ED boarding — which the American College of Emergency Physicians deems a national crisis — and it opens up an available inpatient bed that can be back-filled with a more seriously ill patient. 

Additionally, hospital-at-home represents an alternative admission pathway that can decrease ED challenges such as patients who leave without being seen or registering.  

On the financial side, the single episode (DRG) cost of hospital care to the health system is higher than the cost of a hospital-at-home admission, making the model a first-in-line choice for certain episodes of care. 

Alternative Pathways to Hospital-at-Home Admission

In striving towards improvement, hospital-at-home programs should be functionally looking to make hospital-at-home admission the default for appropriate patients. We already know that for any given DRG, there is a fixed amount of dollars allocated for that patient’s care. By bringing eligible patients directly home from the ED, the total cost of the episode is assigned to hospital at home, a cost savings to the health system. 

Ideally, there should be a prioritization order of patients to identify for potential hospital-at-home admission: 

• Patients that are ready to be admitted directly from the ED 

• ED boarders 

• Observation patients that are being upgraded to inpatient care 

• Patients already in an inpatient status on the hospital floor 

Direct Admissions to Hospital at Home 

Outside of these admission pathways, there also exists significant potential to build toward a new standard that puts hospital at home in the direct admission pathway. Traditional hospitalizations allow for this; the CMS Acute Hospital Care at Home waiver is limited to the ED or inpatient floor. Hospital-at-home programs with value-based arrangements are currently doing direct admissions, including our joint venture partner Marshfield Clinic Health System, highlighting the need to build payer agreements that prioritize hospital avoidance. 

For many patients, such as the oncology population or other immunocompromised individuals, direct admission to hospital-at-home can reduce their risk of hospital-acquired infection. And pre-hospital admission to the model checks all the boxes for patient satisfaction, while generating higher admissions for the health system and returning financial savings. 

Moving Towards an Integrated Model of Care 

The clear evolution of hospital at home is working toward the capability of doing as much of the patient’s hospitalization at home as is possible. In our joint ventures, health systems such as Allegheny Health Network, Penn State Health and Marshfield Clinic Health System are already moving patients home rather than to the hospital floor. 

Other markets who want to do the same need operational expertise and change management to create avenues of entry that prioritize patients in the right order. Bed placement staff, ED providers and the hospital-at-home staff must evaluate the patient for hospital-at-home admission as a first option.  

Although hospital-at-home has been gaining ground in particular for the past decade, we are still at an exciting phase of growth in what is still a relatively new care model with many opportunities for innovation. At Contessa, we’ve developed clinical and operational workflows that are capable of supporting scalable programs and novel approaches to elevating the possibilities that hospital at home offers.  

Our Recovery Care Coordinators are experts at identifying eligible patients. Our clinical and operational leadership teams are seasoned at working with hospital leadership, case managers, physicians and others to create practical workflows that enhance integration of hospital at home into a health system’s approach to care delivery. As this model of care continues to evolve, we will continue to leverage our experience with developing payer agreements that support value-based hospital-at-home care and more robust admission pathways.  

In the next decade, what could hospital at home mean to your health system? We’re looking forward to discovering that together.