Dr. Caroline Yang is an MGB home hospital physician.
Photo: Dr. Caroline Yang
Dr. Caroline Yang, a Mass General Brigham Healthcare at Home provider, said she's "excited" about what is ahead for hospital-at-home programs now that the federal government has approved a five-year extension of pandemic-era waivers as part of a government funding package passed on Feb. 3.
"I think in the long term, we'll allow for more equitable access for various patient populations," Yang told Healthcare IT News. "As we move forward, our focus will be on equity, data-driven care and then being able to scale."
We spoke with Yang recently about what she believes providers of acute care-at-home programs will be working on over the next five years, and which technologies are likely to flourish.
Q. As a Mass General Brigham Home Hospital physician, how has acute care at home changed in the post-pandemic era?
A. Since the pandemic, I think home hospital has become more widely known and accepted by providers and patients. It has offered an option for patients to continue receiving quality care in the comfort of their own homes. At the same time, it allows providers the opportunity to meet patients where they're at, to understand their unique living environments, what they need and their support system.
In my experience over the past five years working as a home hospital doctor, patient volume has grown immensely and our staffing models have evolved. Also, the tech we use, such as remote patient monitoring, has become more advanced, and we've expanded many of our clinical pathways.
And so with all these changes, home hospital in general has been able to care for higher-acuity patients and a wider range of clinical conditions across a wider geography.
I think we've also seen a maturing regulatory and reimbursement landscape that's starting to recognize the value of home-based acute care. Acute care at home has become more standardized over time, and we're starting to develop best practices through understanding the data.
Part of the journey, and the end goal, is to build greater parity with inpatient care at brick-and-mortar hospitals and be able to say that home hospital, or home-based acute care, in its own right, and for the right patient, is as good.
The post-pandemic era has been really inspiring and encouraging to see where we're going and how much experience we've built to move home hospital forward. Moving away from a temporary pandemic solution to something more lasting is really the name of the game right now. We're collaborating and sharing knowledge with other home hospital programs in the U.S. and other countries to do so.
Q. What are your thoughts as a physician on the five-year extension of the AHCAH program?
A. Since 2020, there's been rapid growth of the home hospital landscape and just the number of programs since the waiver started. The legislation was the impetus providing a sustainable financial model for hospitals to provide inpatient care in the home, while also maintaining quality of care and optimizing brick-and-mortar bed capacity.
With this waiver being under threat of expiration multiple times over the past five years, I think many clinical programs have struggled to navigate the future of home hospital and the uncertainty of it. I think industry and innovation around home hospital solutions have been paused and anxiously waiting on the sidelines to see if there's longevity to really invest in innovation.
But with promised reimbursement through 2030, we now have a reliable five-year runway to push forward and deliver high-quality inpatient care in the home.
I'm confident that we can continue to demonstrate the value of home hospital and the value it brings to the system, providers and patients. We can use that data – the outcomes, effectiveness, safety and quality – to advocate for permanent policy.
Using these five years to build a case is very valuable. However, what reimbursement looks like is yet to be seen, in terms of what's fair and what's appropriate. This five-year runway will help us to determine that as well. I am really hopeful, and I think the extension means that health systems can really invest in enhancing their home hospital workforces, look at new technologies and adopt and integrate new technologies that expand clinical pathways.
There's just so much opportunity for growth and creativity to look at how we can optimize this care model in a way that sustains and grows.
Q. What do you see changing for hospital-at-home patients under this new level of certainty?
A. I think for patients, the quality of hospital-at-home care will only continue to get better.
We've seen so much improvement already as we learn, and I think new technologies will improve efficiency – remote patient monitoring, patient communications and other functions – that is imperative for success.
More providers will become familiar, and that's key. When they are well-versed in acute care at home, it will increase patient access to it. There will be more collaboration and seamless transitions with primary and specialty care teams to build better transitions from inpatient to post-discharge care. Closing gaps after discharge will really ensure that patients can stay at home, out of inpatient care settings, as long as possible.
There will be a greater awareness among patients about what home hospital can offer them, and I'm sure that will help evolve how home hospital is delivered.
Q. Which aspects of acute care delivery in home environments do you expect to see evolve over the next five years?
A. The first thing that comes to mind is remote patient monitoring, which could include intermittent and continuous monitoring.
There's a big opportunity for developing higher accuracy and reliability of device data, reducing noise and generating more meaningful and actionable insights. Building clear alarm and escalation protocols and seamless integration with third-party technologies – whether it's software or other hardware – will also continue to evolve.
Logistics, care orchestration, supply chain management of home hospital, automating time-consuming manual processes, optimizing scheduling and more will also evolve. Visits for home services, medication delivery and supply delivery introduce the opportunity to utilize artificial intelligence to optimize processes like inventory management and right-size services to each patient's needs at a given time.
The mission to ensure that the right care is delivered to the right patient at the right time will continue to improve through better logistics and care orchestration technologies.
Right now, we're using virtual care solutions, though suboptimally. Patient communication will continue to improve and evolve over the next five years.
There will also be progress on patient identification and better predictive analytics for understanding which patients are good candidates for home hospital, so that we can deploy the right resources and better support for patients to ensure more successful in-home hospitalizations. We'll be able to standardize protocols and workflows within each program, but also across programs over the next five years.
With greater knowledge sharing, home hospital programs across providers will be of similar quality and experience for patients. This is currently not the case for home hospital, but I'm really hopeful that we can get there with enhanced interoperability across digital platforms, devices and electronic health records so care teams operate from a single source of truth that maintains security and patient privacy.
Q. Which technologies will be most needed to keep up with the potential demand for these programs?
A. To keep pace with growing demands, technology is the king. To really scale, you only have so many human beings. With workforce shortages across the board in healthcare, we really need to look at technology to be that enabler of growth.
Interoperability, standardization of patient identification, remote patient monitoring, patient communication and logistics care orchestration all need to be supported and enhanced through technology.
While largely a hot topic, there's a big window of opportunity for AI automation around remote patient monitoring platforms, including intelligent logistics, scheduling tools, integrated virtual care solutions and data platforms, to bring information from home hospital programs into clinician workflows. It will be vital to manage large patient volumes across large geographies.
We're really limited by [street] traffic and getting our teams to the right places. How far we can stretch our human touch really relies on technologies that are in the home and provide data to us remotely.
However, there has to be a balance between standardization/protocolization and personalization, agility and adaptability of care that is grounded in the unique needs of each patient. There's only so much technology can solve.
That's where a lot of my excitement is – around where innovation is going to go, and what industry players are going to come up with to enhance and scale hospital-at-home program growth.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
