Hospital-at-home programs continue to grow

Many home health agencies and other providers have begun launching hospital-at-home programs. Lifespark, a senior health company that provides primary care, home health and hospice services, and owns 40 senior living facilities in Minnesota and Wisconsin, said it intends to launch a hospital-at-home program by the end of the year.

According to Lifespark founder and CEO Joel Theisen, Lifespark's hospital-at-home program will target the roughly 25,000 older adults that Lifespark takes on full risk for through value-based care arrangements under Medicare Advantage plans. Theisen added the program will likely include collaboration with hospitals.

"We can intercept at the hospital and transition [them] early to acute-care-at-home," he said.

Meanwhile, in-home healthcare provider DispatchHealth has struck partnerships with home health providers CenterWell, Elara Caring, Enhabit, and Home Instead to provide hospital-level care to patients.

DispatchHealth sends emergency medical technicians and nurse practitioners to patients' homes to evaluate them under the virtual direction of a physician. Any patients that require hospital-level care can be enrolled in DispatchHealth's acute-care-at-home program, which is covered under many Medicare Advantage plans as well as managed Medicaid plans and private health plans.

"We essentially receive a bundled payment for that episode and we provide all of the necessary care," said DispatchHealth founder and CEO Mark Prather.

Another home health company, Healing Hands, launched its hospital-at-home program in 2018 and receives reimbursements through CMS' home health prospective payment system, which covers nursing care, telehealth, remote patient monitoring, and home healthcare.

CEO Summer Napier said Healing Hands identifies home health clients whose conditions are getting worse and need acute-level care, then works with primary care physicians to transition the patients into the company's hospital-at-home program. According to Napier, Healing Hands has provided hospital-at-home services to roughly 900 patients.

Questions remain about Medicare coverage

While hospital-at-home programs have continued to grow, questions remain over how Medicare will cover these programs in the future.

Currently, the CMS Acute Hospital at Home Waiver — which was launched in November 2022 and allows hospitals and health systems to treat patients outside of their buildings — expires at the end of 2024.

It's possible that CMS' home health model could be a guide to how the agency considers the future of hospital-at-home, Eastabrook reports. A study by healthcare consultancy Millman found that creating a Medicare reimbursement approach for hospital-at-home programs based on home health payments, with additional payments for expanded services, could be less expensive than a hospital-centered payment.

It's also possible a home health-based Medicare fee-for-service payment would encourage more home health providers to add hospital-at-home services, Eastabrook reports. However, Robert Moskowitz, CMO for Contessa Health, a hospital-at-home company, said it could be challenging for some home health agencies to scale a hospital-at-home program if they don't have the right technology or staff.

"A lot of home health entities might be employing home health nurses, but they're not used to that [higher] level of acuity," he said. "You've got to have the comfort level of competency for the nurse providing the care." (Eastabrook, Modern Healthcare, 7/27)

Use our framework to understand the key factors your organization needs to consider when evaluating a Hospital-at-Home program launch or expansion, including creating a program goal, evaluating the market opportunity, assessing organizational capabilities, and understanding the financial viability.