Achieving the immense potential of hospital-at-home

Healthcare, like almost every other industry, is making a fundamental shift toward more decentralized, personalized and digitally enabled services. By now, most people have experienced the comfort and convenience of a virtual doctor’s visit or a lab test at the local pharmacy. Yet far more is possible.

The “hospital-at-home” model represents the greatest opportunity and the logical culmination of this trend. It promises to bring sophisticated, high-tech hospital care into the patient’s own home, supporting better outcomes, lower costs and less strain on overburdened facilities and clinicians.

While this is a long-term shift, we’re seeing important signs of progress from the technology, policy and health system advances needed to enable hospital-at-home in the years ahead.

Here’s how it works. The hospital offers a patient the option to replace or shorten an in-patient stay if they are a good fit, especially those with well-defined and multi-touch care protocols for chronic conditions like diabetes, COPD, cancer or post-surgical recovery. If the patient opts-in – and most with the choice have been shown to – they receive care at home through a combination of connected medical technologies and regular visits from a nurse, paramedic or other clinician.

The home becomes, in effect, an extension of the hospital – but with much greater comfort. The patient can enjoy their own bed, food and family, at a much lower cost.

While U.S. adoption remains relatively limited, the model has grown since the start of the pandemic and aligns with powerful healthcare trends. More than 290 U.S. hospitals now offer hospital-at-home, through the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home initiative that began in the early days of COVID. It also fits with changing expectations for where and how people receive care with dignity, the rise of smart, connected medical technologies, and the need to address chronic disease in a way that is financially sustainable for both families and health systems.

The early results are encouraging. According to an issue brief from the American Hospital Association (AHA), people who have tried hospital-at-home have expressed higher levels of satisfaction with their physician, comfort and overall experience. Better sleep and greater physical activity can support improved health outcomes. A meta-analysis published in The Medical Journal of Australia finds those who received hospital-at-home services had a ~20% reduction in mortality. A study published in Annals of Internal Medicine, based on a small trial in Massachusetts, finds hospital-at-home patients were around three times less likely to be admitted to the hospital within 30 days.

The model also makes financial sense. Health system experts and the AHA report that hospitals can achieve anywhere from ~15% to ~40% lower costs than with conventional hospitalizations. Overall, as our aging societies face growing prevalence of chronic disease, this approach can help keep spending on a sustainable trajectory.

This is the potential of hospital-at-home – but we need further progress to enable implementation and scale.

First, policymakers can make the CMS hospital-at-home initiative permanent, as it is currently set to expire at the end of 2024. This would give hospitals certainty to plan for the future. Second, we can innovate and improve medical technology for the home, automating or remotely controlling features to minimize the burden on the caregiver. Finally, healthcare organizations can further refine the model to be more scalable, finding the best approach for staffing, eligibility, workflows, treatment protocols and other factors.

Beyond the technical solutions, this is also a social shift. Over time, people and families will become more accustomed to the idea of high-quality, complex care provided at home, rather than a lengthy hospital stay or unnecessary visit. In fact, they may even demand it. And while care at home may be seen as a burden for some families, smart implementation can help address the challenge.

With these advances, we can unlock high-quality care at home for conditions that once required in-patient care. That would make it the preferred option for millions of patients – and one of the great healthcare success stories of our time.

More than 100 years ago, hospitals first centralized care and gave rise to modern medicine. Today, extending hospital services to the home can once again revolutionize care delivery, providing a key solution to address chronic disease, support aging populations and bolster health system capacity.