Cathy, 68, isn’t happy to be in the emergency room again. Every few months, her COPD flares and sends her to the hospital. This time, she vows to walk out if they try to admit her. She can’t take the lack of privacy, the sleepless nights, the needle sticks, or the endless waiting around. Nor does she want to leave her husband and young grandson. The hospital is 30 miles away, so they can only visit on weekends.
Now imagine Cathy’s surprise when the doctor suggests she be admitted—to her own bed at home. The physician explains the new hospital-at-home program to the family, who can barely believe their ears. Such an idea seems almost laughable! But having Cathy at home will save them time and travel expenses while allowing them to be at her side.
The hospital-at-home model is one way health systems meet consumer and cultural demands for better access, equity, and experience in healthcare. At Vituity, we call this new patient-centric paradigm Health in Place, and we believe that it will quickly become a crucial differentiator for our hospital partners. Here’s how hospital at home fits into this paradigm shift and evolves the patient experience.
What Is Hospital at Home?
Hospital-at-home programs deliver an inpatient level of care to patients in the community via telehealth, remote monitoring, and mobile care teams. These programs are most appropriate for medium-acuity patients whose conditions have well-defined treatment protocols (e.g., COPD, heart failure, and COVID-19 not requiring ICU care). Some hospital-at-home programs also provide transitional care that allows complex patients to leave the hospital sooner.
Hospitals at home are common in Canada and the United Kingdom. A robust body of research shows they reduce costs while boosting outcomes and patient satisfaction. However, until recently, this model never gained traction in the U.S. due to cultural and reimbursement barriers.
That changed during the pandemic, as hospitals sought to increase capacity ahead of potential surges. In 2020, Vituity partnered with Adventist Health Central Valley Network to open a 150-bed hospital at home in one of California’s most underserved regions. The Veterans Health Administration, Mayo Clinic, Kaiser Permanente, and other leading health systems have also invested in this model. In 2020, CMS launched the Acute Hospital Care at Home program to provide equitable reimbursement for hospital at home.
Hospital at Home Benefits
The hospital-at-home model aligns with the quadruple aim of patient experience, population health, reduced costs, and provider wellness.
The Adventist Health Hospital@Home program is an excellent example. While it started as part of the system’s pandemic response, it also greatly expanded access across this medically underserved region. Like Cathy, many Central Valley residents must drive long distances to visit the nearest hospital. Hospital@Home eases this burden with mobile nursing and ancillary teams, virtual rounding by hospitalists, and remote monitoring via a nurse command center. The program has gotten excellent feedback from patients—many of whom can’t believe their good fortune.
In addition to treating patients with acute needs, Adventist Health in partnership with Vituity has expanded the program to provide transitional care for complex patients newly discharged from the hospital. This post-acute safety net shortens hospital lengths of stay and lowers costs while offering peace of mind for patients and families. It also provides easily accessible follow-up care in a region where medical offices (like hospitals) are sparse and often distant.
Patients aren’t the only ones delighted by Hospital@Home. The program also gets rave reviews from Vituity clinicians, who say the telehealth component allows them to spend more time with patients. In addition, virtual “house calls” enable clinicians to address social determinants of health such as caregiver fatigue, inadequate housing, and food scarcity. By connecting patients with needed services, providers help to improve quality of life—which makes their work even more rewarding.
A Bright Future
To the delight of Cathy and her family, the hospital-at-home program was everything the doctor promised. Nurses visited her at home twice a day, and the hospitalist teleconferenced daily with the family. Surrounded by support and comfort, Cathy recovered quickly and was “discharged” from the program in just four days.
Health in Place envisions a new patient experience in which hospitals extend care beyond their walls to all who need it. Programs like hospital at home reduce the emotional and financial burdens of a hospital stay, greatly enhancing quality of life for patients and their families. As someone who (like you) chose a career in healthcare to make a difference, I can’t wait to see where this new paradigm leads us.
Denise Brown, MD, is Chief Growth Officer for Vituity, and one of the drivers behind Vituity's expansion as an integrated multispecialty organization. She is a strong proponent of the positive impacts of integration on the patient experience and on the day-to-day work environment of providers, and inspires and empowers others to champion this approach across hospitals and health systems.