The Future of Hospital Care at Home, With or Without CMS Waivers

When the Centers for Medicare and Medicaid Services’ (CMS) introduced its Hospitals Without Walls program in March 2020, health systems could finally provide acute care services beyond their walls, in locations like patient homes, and be properly reimbursed for it. The pandemic created a clear need and demand for these services, and the program became an undisputed win, albeit a temporary one, for providers seeking to offer alternative sites of care. 

Then, in November 2020, CMS went a step further and announced it would cover hospital-level care at home for Medicare fee-for-service patients. This gave roughly 38 million beneficiaries the opportunity to receive needed care in a more comfortable, convenient place, the home.  

These decisions launched healthcare into the future, benefitting patients, providers, and payers alike, and it’s been too successful to turn back now. More than 200 hospitals across 92 health systems in 34 states have already received approval to expand where they provide care, and those numbers are increasing by the week. Patients have also overwhelmingly embraced hospital-level care at home, with Contessa’s partners reporting an opt-in rate of 90 percent and an average patient satisfaction rate of more than 90 percent.  

But the outlook on these fee-for-service waivers is changing, and it’s demanding more from providers. Last week, a bipartisan bill was introduced that would extend the waivers for two years past the expiration of the public health emergency. But if the bill fails to pass and the waiver program ends, advantage will go to those who have figured out a managed care strategy that allows them to provide complex, at-home care based on value.  

What The Future Holds 

Without a sustainable managed care strategy in place, the issues facing health systems today could deeply affect operating efficiencies, reimbursement, and overhead costs. Take the ongoing staffing shortage, for example. Clinical teams are stretched thin nationally. Yet for our JV partners across the country, Contessa helped save approximately 8,000 actual patient bed days. Partnerships like Contessa’s, rooted in value-based care, can remove burdensome work from hospital staff while offering improved outcomes, a better experience and significant cost savings. 

Fee-for-service waivers have undoubtedly helped boost awareness and adoption of hospital-at-home services throughout the pandemic. Forward-looking health systems are recognizing that it will be most sustainable and financially savvy to focus on value-based care and building a strong managed care strategy. If hospitals refuse to evolve to meet patients where they are and get paid for it in a way that rewards better outcomes, the long-term impacts could continue to drive up the costs of care for all parties. Ultimately, the future of healthcare is in the home, with its foundation in value-based care, and we are proud to be a part of that evolution.