Johns Hopkins is generally cited as the first to pilot the Hospital at Home care model over 20 years ago. The model has been subsequently adopted by the VA and overseas in Australia, Canada, Israel and the UK among other countries. CMS first tested the model in 2014 when it awarded Mount Sinai a grant to test the model, however, the model was not expanded having failed to the meet statutory criteria for expansion. In order to better manage hospital capacity and reduce COVID infections, in 2020 under its waiver authority CMS allowed hospitals to provide alternative sites of acute care including homes. Per research published by CMS this past December there are 186 hospitals across 33 states that have implemented the AHCaH model. Currently, CMS' AHCaH model will last last as long as the Public Health Emergency (PHE) - that HHS just extended until July. Hospital at Home research findings have been on balance favorable. For example, research published in 2018 in JAMA found hospital at home patients had comparably lower rates of readmissions, ED and Skill Nursing visits and were more likely to rate their hospital care highly, research findings are however compromised by selection bias.
During this 35 minute discussion Ms. Burbine and Ms. Smith by providing additional model details, i.e., where care can be provided, how patients enter the program, what conditions are treated and related details. The interviews moves on to discuss participation rates, broadband prerequisites and EHR technology, clinical findings or results achieved, required pre-requisites for providing acute care at home, how AHCaH aligns with fee for volume medicine, participation in the commercial market, relationship to patient self-management, proposed legislative and regulatory policies to expend the model and takeaways from related experience overseas.
Ms. Tina Burbine is Vice President Care Innovation & Enterprise Analytics at HealthLink Advisors. Tina has over 25 years of value-based care, population health and healthcare IT experience. Throughout her career Tina has focused on shaping the strategic approach for health systems moving to value-based care enabling teams to focus on keeping their patients healthy, addressing rising risk and improving the health of those with chronic conditions through evidence-based, cost-effective care delivery. This includes establishing payer partner relationships, network management, provider relations, and technology enablement to support innovative community-specific care models. Tina serves on the Arizona HIMSS Chapter Board, lectures at the University of Arizona’s BioMedical Informatics College Fellowship program and hosts a podcast called “Let’s Talk Data!" Tina earned a Bachelor’s degree from Northern Arizona University and an MBA from the University of Phoenix.
Ms. Yolanda Smith is Chief Clinical Officer at HealthLink Advisors. Yolanda has accrued 35 years of experience in medical care, having served as an ICU nurse, clinical care educator, and consultant throughout her career. She is currently focused on operational care delivery redesign for Hospital at Home (H@H) and Community Care enablement, strategy, and performance to make sure patient needs are anticipated and met. Yolanda has served as the curriculum developer and trainer for SEIU 1199, creating and implementing extensive and intensive in-services, curricula, and seminars throughout New York State for hospitals and healthcare systems across the care continuum. Yolanda is a licensed RN, holds an MSN, and is pursuing a Doctorate of Nursing Practice (DNP) degree in the Healthcare Systems Leadership Specialty Track at Chamberlain University.
The NEJM overview by CMS staff of the AHCaH model is at: https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0338. Related clinical findings published in Annals is at: https://www.acpjournals.org/doi/10.7326/M19-0600. CMS' FAQ regarding the AHCaH model is at: https://www.capc.org/documents/download/882/.