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United States Hospital at Home Programs: Challenges, Solutions and Perspectives - 2023 Report

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  • May 2023
  • Region: United States
  • Chilmark Research
  • ID: 5807628

Hospital at Home: Past, Present, Future

The COVID-19 Public Health Emergency accelerated the demand for models of care that could address patient needs beyond the clinic. As of publication, there are currently 281 hospitals across 125 health systems and 37 states participating in the Centers for Medicare and Medicaid Services Acute Hospital at Home (HaH) waiver program. There has been much discussion of the PHE’s impact on the adoption of virtual and tele care offerings, but there has still been only minimal coverage of the opportunity for shifting non-critical, acute hospital care into the home despite this rapid growth of CMS-approved programs.

A research analyst and the lead author of this report had the following to share on the growth of this care delivery model over the coming years: “With healthcare spending skyrocketing and the need for bed capacity growing every year, these new technology-enabled, hospital-at-home models can take some of the burdens of the financial strain to the industry. Expect slow adoption over the next few years as growing pains are worked through and reimbursement models catch up with proven demand. Given the market dynamics uncovered during this research, we anticipate adoption to accelerate after 2026, reaching a market of $72B out of the potential $300B TAM. Payers will remain the largest customer of this segment, but health systems will make up an increasingly large share of the customer base as they see the positive financial benefits of extending their offerings through these technologies and services.”

While there are a few full-stack products currently on the market from companies like Medically Home, Biofourmis, Contessa Health, and Dispatch Health, the majority of HaH programs are built in-house by combining the services of several different point solutions that can enable a comprehensive service offering. The research covers how different innovators are enabling HaH, current accelerants and inhibitors of market growth, and the benefits and challenges of operating these new technology-enabled services models.

This Market Trends Report introduces a new framework for the syndicated content that the analyst produces, looking more deeply into the major trends, initiatives, and social factors that are driving a growing interest in the HaH model. This report will be followed in approximately one month with a corresponding Buyers’ Guide, which will provide a deeper analysis of what it takes to deploy a HaH program, key considerations for buyers to understand before embarking on this journey, and in-depth vendor evaluations with selected case studies demonstrating how leading innovators are enabling new ways of bringing care to the home.

Table of Contents

1. Introduction
2. Why Hospital at Home Now?
  • CMS Quadruple Aim
  • Growing Popularity
  • Beyond CMS
  • Benefits
  • Challenges
  • Shift to Consumer-Driven Care
3. Defining Hospital at Home
  • Program Capabilities
  • Advanced Model
  • Advanced Supplier Ecosystem
  • Vendors Enabling the Strategy
  • Primary Adopters
4. Drivers of Hospital at Home
  • The Growing Role of Medicare Advantage
  • Shared Risk Contracting Driving Effort to Control Costs
  • Connectivity
  • Clinical Logistics
  • The Baby Boomer Effect on Healthcare Utilization
  • H@H Reimbursement
5. Market Forecast and Trends
  • More Beds, Please!
  • Hospital at Home beds
  • Hospital at Home Market Forecast 2023-2028
  • Market-Specific Trends
  • Top Five Trends to Watch
6. Buyers’ Guide Preview
  • Product Categories and Descriptions
  • Caveats and Qualifications
  • Hospital at Home Product Ratings Categories

Executive Summary

Hospital at Home (HaH) has been an increasingly important topic due to its transformative impact on healthcare delivery. This innovative approach allows patients to receive necessary medical care in the comfort their own homes, rather than being admitted to a “brick and mortar” hospital. Hospital at Home brings numerous benefits to patients, payers, and healthcare systems: Added bed capacity, Lower cost utilization per episode of care, Improved care outcomes, Reduced readmission rates, and many more.

Today, we have all the core pre-requisites for successful adoption and expansion of HaH models. With public CMS initiatives and less visible - which doesn’t mean less productive - activity among commercial payers, the HaH model is growing. More and more health systems and payers see the benefits of HaH to improve the care experience for patients/members by getting them home sooner, expand the ability to provide services, and more, driving adoption rates up.

In 2021-2022, the COVID public health emergency contributed to HaH demand and interest. Since then, we have observed a successful march of HaH market leaders like Contessa Health, MedicallyHome, and DispatchHealth. Meanwhile, providers with pre-existing HaH models in place started to discover more modular HaH solutions that could help them extend their current offerings.

Hospital at Home vendors include full suite offerings and DIY enablers.

With a slight delay, EHR vendors are now ready to offer a wide range of HaH enabling solutions - from HaH eligible patient flagging to patient-reported hospitalization outcomes - and without a doubt, will be investing more and more in remote care models moving forward. Epic, Oracle Health, Athenahealth - all of them to some degree announcing HaH-enabling functionality in 2023-2025 road maps. What can we take away from these announcements? The demand to expand these models is strong and growing.

In 2023, gauging the financial waters on the providers’ side, it’s pretty clear: with investments in IT down, and the “official end” of the PHE, HaH adoption is slowing compared to 2022. The duration of this slowing trend is hard to predict, but as soon as the market stabilizes from its current turmoil, I have no doubt that HaH adoption will go back up with emphasis. Meanwhile, payers’ finances are much more stable at this moment in time, and this in turn is reflected in their stable and growing progress in investing in their own HaH models.

We doubtlessly still need more data from CMS to show the full value of HaH, more clarity on reimbursement models, more consumer-friendly RPM technologies and devices, and better integration between systems for this model to really take off. That said, we already have a great and solid foundation to build a solid hospital at home infrastructure and to make this step into the future of health delivery today.

Digital makes our big dreams come true, even in healthcare where the most enthusiastic people break their teeth, trying to make this clumsy giant move. But what matters the most is people, clinicians. Just like my mom was visiting her patients in their homes in 1995, clinicians are making the same trips and providing care with all the technological advantages of 2023. With clinician burn out and a growing nationwide shortage of medical professionals, HaH could become a blessing or a curse for them. To avoid the bad scenario, a robust experience exchange during program development should involve all HaH adopters and stakeholders.

This latest report will help you learn more about what’s happening in the arena of HaH today, and the major trends driving these new initiatives.

Companies Mentioned

  • Amazon
  • Biofourmis
  • BioIntelliSense
  • CareSignal
  • Cerner Oracle
  • Connect America
  • Contessa Health
  • Current Health
  • dina
  • Dispatch Health
  • Epic
  • HRS (Health Recovery Solutions)
  • Lumeon
  • Medically Home
  • Philips Healthcare
  • SignifyHealth
  • Uber Health
  • Validic