More Payers Leaning Into High-Acuity, At-Home Care Could Be ‘Game Changer’

Home Health Care News | By Andrew Donlan 

Hospital-at-home care had a breakthrough moment in the U.S. after the onset of COVID-19.

At the end of 2022, the $1.66 trillion omnibus spending bill made sure that the financial setup that helped get hospital-at-home programs off the the ground during the pandemic would not go away once the public health emergency ended.

But the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver is now just one part of the larger shift to high-acuity home-based care. While that funding mechanism remains, organizations are also finding new ways to fund hospital at home – and new models to bring into the home.

Medically Home – one of the early adopters of a business model tailored around enabling hospital-level care in the home – recently unveiled its “ED in Home” model, which is meant to bring emergency department care into a patient’s home.

“Our primary focus is to build the core chassis to decentralize care,” Medically Home CEO Rami Karjian told Home Health Care News. “So, what you’re seeing here with ED in Home is a natural extension of that primary focus to decentralized care to another use case.”

The Boston-based Medically Home partners with health plans, health systems and other providers to enable hospital-level care in the home, namely through coordinating in-home clinician visits and supplying the necessary technology, medication and equipment.

Its financial backers include the Mayo Clinic, Kaiser Permanente, Baxter International Inc. (NYSE: BAX), Global Medical Response and Cardinal Health Inc. (NYSE: CAH).

The ED in Home program was officially announced in January, though thousands of patients had already been cared for underneath it at that point. While it’s live in Massachusetts, Medically Home is actively working on bringing it to other states across the country, though Karjian declined to name specific ones at this point.

“Adding ED at Home is another use case, and it’s particularly powerful today, because of the access challenges that COVID exposed,” Karjian said. “Patients don’t want to go to the hospital, they don’t want to be in the hospital, they’re finding it harder and harder to get to a hospital. This brings the hospital front door to them in a way that inpatient care alone couldn’t.”

More payers getting involved

CMS and the Acute Hospital Care at Home waiver were the primary drivers of health systems delving into hospital at home in 2020 and 2021. But the model is no longer a niche service offering.

Because of home-based care’s ability to drive down costs, there’s an increasing amount of payers and providers willing to engage.

“The commercial payers are really starting to accelerate the rollout and adoption of this,” Karjian said. “We’ve had a number of the commercial payers in a number of states come to us and just say, ‘How can we work together, along with the health systems, to accelerate this and maybe even provide some of the funding that would allow this to progress?’ So, that’s very exciting.”

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