Care at home: Technology, trust, teamwork all have a place

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Technology, trust, and teamwork are essential components as health systems integrate more care in patients’ homes.

A panel of four health organization leaders discussed their experiences with hospital-at-home care in “Telehealth and Changing Models of Care for the Aging Population,” an online webinar hosted by the American Telemedicine Association (ATA) on Aug. 15.

The goal was to discuss how programs use telehealth, how they were operationalized, and how they use telehealth data to support timely and effective delivery of care, said moderator Nancy Green, chair of ATA’s Healthy Aging Collaborative.

Charlotte, North Carolina-based Atrium Health began its hospital-at-home program in March 2020 to deal with a tsunami of COVID-19 patients coming to hospitals already operating beyond capacity, said health system Vice President Colleen Hole, RN. Patients started out using blood pressure cuffs, thermometers, and pulse oximeters sent home from the hospital, and more technology caught up later, Hole said.

“We’ve since implemented an RPM solution,” Hole said. “It’s been game-changing for us and even for our older patients, who sometimes we think won’t embrace the technology. They absolutely have.”

Homeward Health is “a technology-enabled health care provider delivering care to those who don’t have it,” starting in rural Michigan and Minnesota. Its founders aimed to redesign the meaning of being a provider and of building a health ecosystem in a rural community, said Stephanie Gutendorf, senior vice president for market strategy and development.

She emphasized the need for building trust in developing relationships with providers in rural communities. There’s already “a huge access issue” due to lack of providers, Gutendorf said, and the average age of primary care physicians in rural communities is 62 years, so many of them are looking to retire.

Technology for care at home was not very well designed 10 to 20 years ago. Electronic medical records were designed for brick-and-mortar care or integrated health systems, not delivering care in homes, said Tahir Haque, MD, senior medical director for Biofourmis. That company has a program for managing patients in-person and remotely, and Haque said health care companies providing hospital-at-home care need a care coordination tool that includes components of monitoring, task coordination, inventory management, and communication.

An internal medicine physician, Haque worked at Boston, Massachusetts-based Brigham and Women’s Hospital. It was the first to complete a formal study of cost, safety, quality, and patient experience of hospital-at-home care – with good results.

Technology is crucial, but the best results come from combining great nurses, great technicians, great physicians, “and then that momentum has to just stay there,” said Rich Curry, PT, MBA, vice president of business development for Health Recovery Solutions, which specializes in remote patient monitoring and telehealth.

“I always say people make programs, like, the reason we get results,” Curry said. “Regardless of vendor, and I know I’m a vendor, but it is people that make the programs.”

The ATA has advocated for continuation of allowances that the U.S. Centers for Medicare & Medicaid Services (CMS) granted during the COVID-19 pandemic, when telehealth boomed as patients sheltered in place.

Many of those allowances will expire at the end of 2024. Similarly, CMS’s Acute Hospital Care at Home initiative granted health systems flexibility to treat patients at home, and it will end at next year.

Atrium Health “absolutely emphatically” will continue, Hole said. She and Haque suggested a number of possibilities for paying for that care, although no one yet knows exactly how that will happen.

Federal regulations are important, but there are no uniform rules at the state level, Hole said. For example, in Massachusetts, the Medicaid program has partnered with health systems for hospital-at-home, but that has not happened in North Carolina, she said.

Haque said customers are looking beyond 2024 and determining what to do.

“And the reason being is that patients and providers both love this care model and once they’ve experienced it, they want to continue being treated at home,” he said.