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 Today in Health it, this story is how it should approach hospital at home initiatives. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current. And Engaged Health Lyrics is my company. I develop a quarterly state of health IT report that I can deliver to your team.

These insights can help your leadership, sales, even development teams stay ahead of the emerging trends in health. It. For more information, check out health lyrics.com. All right, today's story. Today's story comes from Healthcare IT News. It's an interview piece. It's a really good interview piece. It is with Tom Kiso, K-I-E-S-A-U, director and leader of Chartist Digital.

At Charters Group and he goes into a lot of detail on this Hospital at Home initiative. I, I like this article for a lot of reasons. Tom's insights are really good. Also, there's a great summary of a lot of the things that we've been talking about on the show with regard to hospital at home. So I'm just gonna dive into the article that the article is titled, how Health Systems Should Be Preparing Now for the Future of Hospital At Home.

Alright, here's the summary. It's safe to say that Telehealth has proved its metal this past year. Now, more providers are looking to expand out beyond video visit based virtual care and pushed for expanded remote patient monitoring programs up to and including acute care at home. Of course, some big questions still need ironing out as regulations and reimbursement mechanisms are in major flex.

The fact that these ideas are even being discussed points to how far the conversation has shifted since the onset of the pandemic. About the same time as Amazon made waves with its 50 state expansion of Amazon Care, we reported that it has teamed with blue chip health systems such as Ascension and Innermountain for a.

Moving Health Home Collaborative, whose goal is to change the way policymakers think about the home as a site of clinical service. So we covered both of those stories. The group plans to lobby policymakers to broaden coverage of care services in the home, including extension and expansion of the. CMS Hospital Without Walls provisions.

Advocate for bundled payment models, home-based care and more. Meanwhile, there's real world progress being made at some of the more forward-thinking health systems. Mayo Clinic being cited there. The Covid 19 crisis has forced providers. To think more creatively about care models and revenue, but even as many are contemplating significant expansion of their virtual care initiatives to take acute care to the their patients where they live.

Many are still pondering next steps. I. And he sets it up as the momentum builds behind the concept of hospital at home. We spoke with Tom Kiso, charter Digital about what those steps should be. He highlighted the importance of identifying the right patient populations, those who most stand to benefit from acute care, remote patient monitoring now.

Do you think we're at an inflection point for virtual care and RPM? Yeah, I really do. And I could stop there and he goes on to talk about why he does. When you think of the home as a care setting with some level of physical interaction, not just the virtual visit at home, but everything else, you can think about the observation in your home.

You can think about the hospital in your home. You can think about post acute care replacing SSNs. You can think about end of life care replacing hospice, and what you're seeing is there's a kind of confluence of factors about comfort with digital care. A big thing that happened last year, CMS finally cleared the pathway with its Hospital Without Walls initiatives in April, and then a big one being the waiver that came out in November.

They cleared the path for parody reimbursement during the public health emergency. So there's a time limit on it, but at least my belief is that a lot of folks who work in this space, it's been long overdue and proven to be effective. Johnson Hopkins has been doing research on this for years. Mount Sinai has been doing research.

It's a better product in a lot of ways, and I think it's absolutely here to stay. And I think so too. I think that's why you're seeing so much momentum. The next question, will the latitude given by CMS during the pandemic continue going forward? And he says, yes, there will be reimbursement for virtual care, but I think you're going to see appropriate pushback on parody.

He goes on to say, the fact of the matter is that hospital to home is cheaper and it gives better outcomes. The research studies that have been conducted show that it's dramatically cheaper, reduces readmissions, and it's just structurally a better product for the patients. . It's appropriate for, it doesn't solve everything.

It's not a replacement for all acute care, but it's a better replacement for some acute care. All right. Let's skip down a little bit on this, and next question I was going to ask about the Amazon piece. I wonder whether the recent Amazon care expansion could itself be enough to push the conversation forward.

And he responds to that with Amazon has made a major business of taking legacy costs and turning them into a revenue center for themselves. AWS is one of the . They're fastest growing and most profitable businesses. It's hard to look at healthcare and not see that there's an opportunity for the same thing, and they've been doing it for years with Amazon Care for their employees.

The question was not a matter of if they were going to roll out Amazon Care. The question was how big it was going to be. And as we talked about, right now, they're just rolling it out for their employees, but it has the potential, if they can do it in all 50 states, for their employees to be a model that they can take to market.

And he. Confirms that. Alright, next question. Leaving Amazon aside, say the policy stuff gets ironed out and more providers decide they want to embrace something like this. What should we be thinking about in order to prepare? And this is probably the question that I gravitate most towards in this article.

Here's his answer. I make it a big point with clients to really do the work of segmenting. Out your clinical populations. The first thing I would say is home-based care is the umbrella. Hospital and home is really the goal of delivering acute care level services in the home. So I tend to look at things like chronic care management as the target for RPM, remote patient monitoring, where the tool is the driver.

As opposed to the hospital at home, which is an integrated and comprehensive wrapper that can provide all the same services, literally all the same services that you would find in an acute care setting, as well as the backstops for the true emergency hands-on situation. There's a bit of a paradox here.

You have to be able to identify the. Clinical populations that are appropriate for the care. Mount Sinai has done a great job there. They posted a paper and made a lot of their research public, but there are a lot of clinical populations, cellulitis, COPD, congestive heart failure, pneumonia, diabetes. There are a large population that often even the consideration of comorbidities and they rule people out.

It represents, uh, as much as 25 to 30% of the hospital's admissions. And so you start thinking about that. Is that the addressable market? Then you have to put in how do we put in place the tools to serve them? And then every payer has different implications for Medicare. Before the waiver, there was no reimbursement.

There was no incentive to move Medicare as a whole towards hospital at home. So when health systems are going to go about looking at hospital at home, specifically the acute care wrapper, there's a specific analysis of what populations are clinically appropriate and what are the financial implications and the economic viability of moving those populations.

Okay, because before the waiver, large chunks were not covered. We're starting to see a lot more signs that the Medicaid plans are going to start considering paying for this. I hear anecdotally that both Massachusetts and California have some legislation being formed around paying for hospital at home for Medicaid.

There are now increasing examples of commercial payers. Either partnering with health systems to offer it or paying directly on a fee for service basis, and that makes sense with all the positive outcomes that we talked about earlier. All this makes sense. He goes on. So if you think of it as a Venn diagram, the economic viability bubble is slowly moving further over that clinical appropriateness bubble, and it's making it easier for organizations to put in place the basic elements that you have to have.

In order to operate hospital to home programs, the 24 by seven clinical command center, the remote patient monitoring tools. And the dispatch services, the legal element, the payer contracts, the rev cycle, and then the technical infrastructure that links all that stuff together. You can't do all these things unless you've got enough of a population to justify the cost, and so you kind of hit this structural holdup.

Where no one can make those investments materially until they solve that Venn diagram overlap. But I think we're getting to the point now where you are seeing enough population appropriateness. It is my belief that it will be part of every health systems delivery channel in the next five years.

Everyone has to be thinking about this. And so if you're wondering why we're hitting this story so hard and why we've hit so many hospital at home stories, that the So what is almost . Obvious in the story itself. That this is the future. This is what's coming down. Once the payment models get in place, you're gonna have to move very fast.

If he's saying in the next five years, that means this is really right around the corner. The last question, let's say I'm ACIO and my colleague is A-C-M-I-O, I. What are the big things we should be doing as prep work right now as we look to the future? And I love when an article does the so what for me?

So here it is for you. It's really about working through the understanding of the population that you intend to serve. It's an analytical exercise. Looking at the data, looking at who you're gonna target, how it would impact them, and then working through the patient's journey. Great starting point, but a lot of organizations have focused on the backend as a starting point.

We're gonna shave a few days off inpatient stays for these Medicare patients. It'll be a better experience for them than staying in a hospital. They'll get better outcomes. We'll minimize readmissions, but it's really not enough. The CMIO, the CIO, the medical director of the ed, the COO, everyone needs to commit to the vision of this different care model.

Bruce left is the godfather of hospital at home and he said that there's nothing intrinsically about this that is not solvable, but it's a lot like riding a bicycle backwards. Your training muscle groups completely different. And so the job of the CIO to my mind is not focusing on the technology, it's focusing on the the use requirements and then demonstrating the efficiency

And the effectiveness of the technology. And finally, because what we found as the impediments to this are usually not technical. It's more can you put a patient into the program and make them comfortable enough that they will actually use it? And you're needing to cover all the considerations of the way things could go wrong from the most mundane stuff like the internet isn't reliable or doesn't work to how does someone get into that house if the patient is by themself and there's a medical emergency.

It's working through the entire journey in a holistic way, and this is a really good article to really set you up and to really . Understand where we are going next with hospital at home, and I'm bullish on this concept. There's so many positive things that can happen here, but there's an awful lot of retraining how we've done things in the past.

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