Health First Sees Success With Hospital at Home Program

By Scott Mace

Health First is seeing great success with its Hospital at Home program, launched during the pandemic with a waiver from the Centers for Medicare & Medicaid Services, and officials at the Florida-based integrated delivery network say they’ll be using remote care management strategies long after the COVID-19 crisis ends.

So far, three of the four hospitals in the system have shifted care for 238 patients from the hospital to the home since the program began in June 2021.

About 11% of those patients had to return to the hospital, the vast majority being treated for worsening COVID-19 conditions, says Mark Rosenbloom, MD, vice president of clinical transformation at Health First.

“We’ve had no mortalities, we’ve had no falls, we’ve had no pressure injuries,” he says. “We have about a 6% hospital readmission rate, which means if you go through the program and you’re discharged, there’s about a 6% chance you may have to be readmitted to the hospital for anything. That’s a lot lower than our all-cause, all-payer readmission rate.”

Patients are supportive of the program, which replaces inpatient (often ICU) care with a program that combines telehealth and digital health services with in-person care at home. Press Ganey surveys show 87% would recommend the program, and 93% give it an overall positive rating, Rosenbloom says.

The program has reduced overall length of stay from a little over five days to around 4.4 days, and as of June 2022, the health system is seeing positive contribution margins, Rosenbloom says.

“Like most of these programs, you’ve got to get to a certain average daily census to start to see the financial benefits of this,” he says.

While patients approve of the program, Rosenbloom says, it took a little more time for providers to buy in.

“Initially, it was, ‘Is this just one more thing I’ve got do?'” he says. “But it really isn’t.”

Of the 238 patients released to the program, Rosenbloom estimates that 10% to 25% of those were released directly from emergency departments back to their homes.

“We want to get more of these folks home before they even come into the hospital,” he says. “That’s what we’re working towards.”

Current Health has supplied the remote patient monitoring and care management technology used by Health First. Typical programs use digital health tools to capture patient data at home and telehealth platforms to facilitate on-demand communications and virtual visits with the patient’s care team, integrated with in-person visits by care team members or home health aides. While most programs are designed to collect and transmit patient data on demand, some can be configured to monitor a patient around the clock, in real time.

“This isn’t [an] ICU at home,” Rosenbloom says of the Health First program. “We don’t need minute-by-minute vital signs, we just need smart vital signs. There was a learning curve. Who needs what remote patient monitoring? How do we set the alarms?”

After-hours monitoring is handled by Health First’s ICU team through a telehealth connection. Initially, that team was inundated by alerts throughout the night, and the health system had to learn how to set parameters to sift out non-emergency alerts and focus on the critical trends. Since making those adjustments, Rosenbloom says, the number of alerts has been reduced.

Many homes in Florida are built with concrete blocks, which can thwart connectivity via either cellular or Wi-Fi connections. To solve that problem, Current Health added additional access points as needed.

The CMS waiver was enacted during the COVID-19 public health emergency (PHE) to help health systems launch hospital-at-home programs and receive Medicare coverage for some of the services. Roughly 220 health systems have taken advantage of that waiver.

That waiver is scheduled to end when the PHE concludes, likely next year, but Rosenbloom anticipates Health First will continue with the program regardless.

“I don’t think the program is going to disappear if the waiver goes away,” he says. “We’ll just have to go back to our original plan and figure out how we will finance it if the waiver goes away.”

“I have to think, however, that that genie is out of the bottle. It’s hard to imagine that all of a sudden, we’re going to stop doing care at home, especially when there’s such a movement around it, and legislation in front of Congress about moving care to home.”

Over time, Rosenbloom says, the program will expand to cover more diagnoses. For example, Health First recently expanded the platform to include patients with renal vein thrombosis.

“We’ve had some diverticulitis patients,” he says. “The typical diagnoses are pneumonia, cellulitis, heart failure, dehydration, COPD, bronchitis, and asthma, but we’ve expanded beyond that. We’ve treated some GI bleeding, thrombocytopenia, and hyponatremia.”

The success of the program is also giving Health First’s health plan some ideas on how to improve care for high-risk members.

“We are giving them some remote patient monitoring, and a tablet, and monitoring them in our digital command center,” Rosenbloom says. “When we see their changes, we can telehealth into them, intervene early, keep them from having to go to the emergency department or, God forbid, have to be admitted to the hospital.”

For Health First leadership, the key is getting staff and patients to think differently about hospital care.

“We’re working on a marketing campaign,” Rosenbloom says. “I’d love for patients to show up in the ED and say, ‘I want you to put me in your hospital at home program.’ We’re starting to get the word out there.”

Scott Mace is a contributing writer for HealthLeaders.