Brigham and Women's Sees Telehealth Success With Home Hospital Program

Dozens of health systems across the country are embracing a program that uses telehealth and mHealth to provide care at home for patients who would otherwise be hospitalized.

Centers for Medicare & Medicaid Services Administrator Seema Verma has taken to Twitter recently to announce new participants in the Acute Hospital Care at Home program, which CMS unveiled last month. The service, which builds off of CMS’ Hospitals Without Walls program launched this past March, gives health systems the opportunity to reduce inpatient volume by treating certain acute care patients at home through a telemedicine platform that allows for daily check-ins and monitoring.

David Levine, MD, MPH, MA, a physician and researcher with Boston’s Brigham and Women’s Hospital who helped develop their Home Hospital program in 2016, calls it “a huge step forward” for value-based care.

“If Home Hospital were a drug, every insurer would pay for it immediately,” he says.

The program, Levine says, basically recreates a critical care platform in the home, using clinical grade mHealth sensors, telehealth technology and in-person care to provide care management for patients meeting the criteria. Patients are screened when they arrive at the hospital’s Emergency Department, and if they qualify, they’re sent back home – with a team from the hospital meeting them there in about 20 minutes to set up the program.

In a study of the pilot program launched in 2016, Levine and his colleagues reported that it improved care outcomes for those patients while significantly reducing costs.

"Hospitalization represents about a third of the roughly $1 trillion in annual health care expenditures in the United States," he said in a 2018 press release highlighting the program and study. "Saving a nice chunk of that through home hospitalization would produce massive savings that could be directed toward research and other public health endeavors."

Levine, who’s authored a few studies on the program as it has evolved, says success lies in developing the right protocols for patients, finding the right technology to meet those needs and finding the right providers to manage care.

“Hospitals don’t have expertise in home care,” he notes.

Brigham and Women’s, which adds five to 10 new categories for Home Hospital care every few months, has developed that expertise. Levine says protocols are designed carefully and specific to the patient’s condition, sometimes looping in specialists or rehab care.

“Some of these workflows are novel clinical workflows,” he says.

The technology is clinical grade, rather than consumer grade, with companies like Biofourmis working with Levine and his colleagues to fine-tune their virtual care offerings.

All of this data from the home is pulled in through a series of apps to the care team at Brigham and Women’s, but it isn’t automatically integrated with the electronic health record. Levine says EHRs haven’t reached that stage yet where they can easily integrate connected health data. He envisions a day when a plug-and-play ecosystem is created with a stable HL7 or FHIR interface that accepts all the data and seamlessly integrates with the medical record.

For now, Levine and his colleagues are working on expanding the program, and they’re celebrating last month’s CMS announcement. With the new individual waiver, they’ll be reimbursed through Medicare for those services during the public health emergency created by the coronavirus pandemic.

“We now have a clear source of revenue,” he says, noting the program had been supported in the past by grants and population health funding. “Now we are a fee-for-service proposition.”

But only for a limited time. A program that, Levine says, has helped improve health outcomes for complex patients, boosted patient and caregiver engagement and reduced provider stress and burnout will stay on the CMS payroll while the PHE is in effect. Once that ends, the agency will need to evaluate whether to continue with those reimbursements.

Levine, who’s part of a user group of US and Canadian hospitals formed to advance the Home Hospital concept, says they’re gathering as much data as they can in the time they have to lobby CMS to make that coverage permanent. And they’re asking providers to submit feedback during the public comment period on the waiver – which ends at the end of this year.

"While the cost savings are important, what's even more important is the care we deliver," he said in the 2018 press release. "Patients deserve high-quality, safe care and a great care experience. We deliver all of those either just as well or better at home"