Mass General Brigham's hospital-at-home plans

Mass General Brigham has announced it plans to shift 10% of its inpatient care to hospital-at-home within the next five years. Currently, both Brigham and Women's Hospital and Massachusetts General Hospital offer hospital-at-home services that amount to 30 beds per day, but the health system said it wants to increase that service to 200 beds per day within the next few years.

The investment comes partly in response to an aging population that will have greater healthcare needs, Modern Healthcare reports. According to Heather O'Sullivan, president of Mass General Brigham Healthcare at Home, the investment is also a way to cut costs.

Research published in the Annals of Internal Medicine in 2018 found that treating patients at home is 38% less expensive than inpatient care, and other research published in 2021 found that readmissions among hospital-at-home patients were roughly half the rate of patients treated inside a hospital.

O'Sullivan said Mass General Brigham is taking the opportunity to create a path other providers can follow. "It is our imperative as a system to build the playbook for other hospitals or even systems that don't have the support or encouragement that [Mass General Brigham] has placed on this," she said.

Currently, the health system is awaiting word from CMS over whether Medicare will cover hospital-at-home services at parity with inpatient care. CMS is collecting data from over 400 hospitals in its waiver program to determine whether Medicare will develop a new payment policy.

But regardless of CMS' decision, Stephen Dorner, chief clinical and innovation officer of Mass General Brigham's hospital-at-home programs, said the health system needs to develop a sustainable hospital-at-home program.

"We have to build a business model that can deliver the same care that's necessary within the home, while fulfilling the need to function as a business," he said.

Specialty services at home

Meanwhile, in-home care provider MedArrive announced it will partner with Heartbeat Health this fall to offer on-demand cardiovascular services at home.

Nurses and emergency medical technicians with MedArrive will be sent to patients' homes to assess them and connect them with a cardiologist from Heartbeat Health to determine whether they need an immediate consultation. MedArrive will also provide on-site electrocardiograms, lab tests, and other evaluations, and the cardiologist will be able to virtually prescribe medication or refer patients for other treatment.

"There may be patients that need to have a stent put in or may need to have further diagnostics with a brick-and-mortar cardiologist," said MedArrive CCO Rocky Samuel. "Heartbeat can prescribe exactly what that patient needs so that we can better facilitate them."

MedArrive said increased rates of cardiovascular disease and rising costs prompted the new program, and that MedArrive is also looking to expand into obstetric care for low-income mothers and palliative care.

As home health companies continue to expand, many are starting to offer specialty services as a way to increase revenue and profits, Modern Healthcare reports. For example, DispatchHealth currently offers in-home care in 30 states and started offering in-home cardiac care in partnership with the Pulse Heart Institute in January. In addition, Dispatch last month announced a partnership with Reimagine Care to provide in-home services to cancer patients in Texas.

"The model has always been how do we do this in a very cost-effective manner that is scalable because, at the end of the day, we can't use venture capital to pay for our visits," said MedArrive co-founder and CEO Dan Trigub. "That money is going to run out and we're not going to be here for the long term." (Eastabrook, Modern Healthcare, 8/7; Eastabrook, Modern Healthcare, 8/15)

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