A group of physicians and nurses are working with patients at Brigham and Women’s Hospital in Boston, MA to fine tune a pilot program that avoids hospitalizations altogether. Patients were selected based on criteria set by the organizers that would be able to be managed by a daily visit by a physician and two daily visits by a nurse.
While the patients were in their own home, the staff first had to conduct a safety assessment and determine whether or not the patient would comply with orders at home. In the pilot program, which has turned into a 500-patient rollout, all initial expectations were exceeded.
The program is successful due to its leverage of technology to bridge the gap between hospital and patient. The use of tablets with messaging applications and video chatting combined with a remote monitor to measure and report vitals are all an integral part of the ‘hospital at home’ model.
The current model is based on an Australian/European concept of allowing patients to heal and receive treatment within their home rather than staying in a hospital. Not all patients who are admitted to the ER qualify for this program even though it shows substantially better recovery outcomes.
Brigham and Women’s has set a strict 5-mile radius from its campus as the boundary for determining if a patient would be approached for participation. Patients who live within the area, are willing and able, and meet the criteria will qualify for the program if they choose. Of course, patients still have the option to be admitted for inpatient treatment. In the initial group of 20 patients, every patient asked agreed without hesitation.
Home health agencies should take notice of this program and other innovative pilots that are being used across the country. The typical model of home care is under siege and is going to come under attack from all sides. The Brigham and Women’s model essentially drops the use of a home health agency in favor of using its own hospital staff. It should be noted that Brigham and Women’s, through common ownership of Partners Healthcare, also owns a large home health agency to which all of its patients are automatically diverted. If a hospital is going to be circumventing their own home health agency in favor of providing care directly themselves, who’s to say the referrals that come from your local hospital will continue long into the future?
It’s time for agencies to innovate and create more strategic partnerships. Whether this is with a hospital or other type of provider, agencies must learn to adapt and not continue on the current path of simply sending nurses and therapists into the home. This model is quickly going to be replaced with advanced teams who are able to go beyond the scope of a traditional agency and in some cases, to go beyond the comfort level of many current agencies with the services they can provide in the home. The threat of the HHGM, 30-day episodic model, in which therapy is removed from revenue calculations, supports this idea. Its potential implementation in 2019 could be seriously disastrous for many agencies who sit on the sidelines while others are not just adapting, but are reshaping the future of home health.