In an interview with Chief Healthcare Executive, he discusses the momentum for home-based acute care and what health systems should do to succeed with it.
During the COVID-19 pandemic, more health systems began offering hospital-at-home programs, and clinicians involved with the programs say they provide big advantages for patients.
Rami Karjian, the co-founder and CEO of Medically Home, a company that works with health systems to provide hospital care at home, thinks those programs are part of the future of patient care.
“There is no reversing this trend for its transformation,” Karjian tells Chief Healthcare Executive®.
The federal government eased regulations on home hospital programs during the pandemic, and they have grown substantially in the past three years. As of Oct. 26, 126 health systems, and 296 hospitals, were offering home-based hospital services in 37 states, according to the Centers for Medicare & Medicaid Services.
Hospitals who have launched home hospital programs say they’ve seen encouraging results, with fewer patients being readmitted. They say patients get more rest in their own homes and enjoy being closer to their loved ones, as opposed to seeing them during visiting hours.
“It's better for patients,” Karjian says. “It's better for the clinicians, physicians and nurses who serve them. And it fixes a massive capacity problem that we have in the country, where arguably, we have too many beds, but they're in all the wrong places.”
In an interview with Chief Healthcare Executive®, he talks about the growth of hospital-at-home services, what health systems should think about in providing acute care at home, and the future for Medically Home as well. (See part of our conversation in this video. The story continues below.)
‘The most powerful aspect’
Based in Boston, Medically Home works with more than a dozen health systems, including the Mayo Clinic, Kaiser Permanente, Cleveland Clinic, UNC Health, Yale New Haven Health and others. Mayo Clinic and Kaiser Permanente invested a reported $100 million in Medically Home in 2021 to advance hospital-at-home care.
Karjian says more hospitals saw the value of home-based care during the pandemic, as health systems wanted to protect patients from exposure to COVID019. He calls it a “very, very powerful push for this entire movement to decentralized care.”
Clinicians working with hospital-at-home programs tout plenty of advantages, including lower risks of infections, better rest, and less confusion.
Patients with pneumonia or those recovering from surgery can get what they need at home, under a properly managed hospital-at-home program, Karjian says. They can get IV antibiotics, regular visits from nurses and contact with doctors virtually in the home.
“All of that can be safely provided in a patient's home where they have all the benefits of being at home and having access to their caregivers faster than they normally have access to caregivers in the hospital,” he says.
Hospitals working with Medically Home have doctors and nurses operating in a medical “command center” around the clock, while nurses visit with patients in the home. Mayo Clinic’s command center is based in Jacksonville, Florida, and supports home hospital patients in and around the city, as well as patients in Phoenix and Eau Claire, Wisconsin.
While there are virtual components to hospital-at-home services, providers also send nurses to see patients in person. Federal regulations require hospitals to provide visits to the patient’s home at least twice a day.
For health systems launching acute care services at home, it’s best to begin gradually, Karjian says.
Health systems should begin with a small number of patients, and perhaps focus on those with less complex conditions.
“When health systems launch with us, the first month, they're taking maybe 30 patients that month, then the next month that may be 40 or 45,” Karjian says. “And then it's growing every month.”
As the health system gains more experience in delivering acute care at home, they can accept more patients and more high-acuity patients.
“There's definitely a learning curve because this is a high acuity model for patients who are really sick, who are entrusting their lives into the health systems that are doing this,” Karjian says.
Hospitals have to shift to “decentralized” care built around the patient, and that can be a big adjustment, he adds.
“The most challenging aspect is also the most powerful aspect,” Karjian says.
“The heart of why this is so hard, is because now you've got distributed care,” he adds. “You've got to get the X-ray to the patient, not the patient to the X-ray. You've got to get the IV antibiotics to the patient, the ultrasounds to the patient, the nurse to the patient.
“So it's one of the most powerful parts of this model, that all of this revolves around the patient in the safety and comfort of their home. But it's also the logistics of doing that, at scale, that make this so, so hard for health systems that have been organized, so far, around the patient going to the things that they need, or that care happening in centralized locations, big buildings.”
Don’t think of it as a program
When asked how health systems that are starting or planning to offer acute care in the home, Karjian says hospitals shouldn’t think of it as just “a program.”
“The most successful institutions that are doing hospital-at-home think of it as another floor or two or three floors, on top of their existing hospital. Those floors happen to be in the patient's homes,” Karjian says. “There's something temporary sounding about a ‘program’ versus a service line, a way that you're now going to make the standard of care for eligible patients to provide that care.”
For health systems having the most success with hospital-at-home services, Karjian says, “What we see is physician leaders, nurse leaders, administrative leaders, who deeply believe this is the best thing for their patients and for their institution, and are committing and thinking of this with the same rigor and structure.”
Health systems also need to make initial investments into home-base acute services similarly to the investment in adding floors to the hospital, he says.
In the future, Medically Home hopes to be working with health systems to provide more and more care at home.
Some cancer patients are already getting chemotherapy at home, and Karjian says he’d like to see more services for cancer patients delivered in their own homes. He also sees potential to offer more care at home for patients with kidney failure. In the future, Karjian says he’d like to see the company help offer hemodialysis in the home.
“So that's what we think about,” Karjian says, “How do we keep giving more and more patients in more and more places in the country, this model of better care with the health systems who are excited, who are committed, who have conviction that this should be the new standard of care?”
Karjian says Medically Home provides a “chassis” for health systems to provide acute care at home.
“What we expect to see is that chassis being used for more and more use cases,” he says.