How 3 Health Systems Are Scaling Hybrid & Home-Based Models

Health systems across the country are scaling hybrid and home-based care models by integrating virtual visits with in-person services, deploying remote monitoring technologies, and partnering with home health providers to increase access while reducing costs. These new models aim to improve patient outcomes — as well as meet the growing demand for care that is more convenient and personalized.

Leaders from three different health systems detailed how their organizations are maximizing hybrid and home-based care models last week during a virtual panel held by Bright Spots in Healthcare.

Providence

Providence’s at-home care strategy is heavily reliant on remote patient monitoring, noted Kate Baars, an executive director for product development at the health system’s virtual care and digital health division.

The West Coast-based health system’s remote patient monitoring program focuses on patients with hypertension, Type 2 diabetes, congestive heart failure and COPD.

“We want patients who are actively engaged with their primary care physicians, so who have had a visit within the last year. And then we look at where we have clinical excellence targets or criteria across our system — so we’re enrolling patients that have blood pressures above 140 over 90 for our hypertension program, or A1C over 8%, because those are systemic things that we’re looking at. Or [congestive heart failure] patients that have had an ED visit or an admission in the last year,” Baars explained.

When establishing its remote monitoring program, Providence wanted to do so in a way in which physicians could maintain their autonomy, she added. The provider has to agree to recommend the program to their patient before the patient is ever approached about enrolling, Baars explained.

She also said that Providence’s providers are aware that the program is an extension of their care, not a separate offering.

“This just honors that relationship and trust that our providers have with their patients — we keep our providers engaged every step of the way, which has been really fantastic in terms of both driving adoption and driving the clinical outcomes that we’re able to see in this program,” Baars remarked.

The program has done a good job of preventing avoidable emergency department visits by allowing clinicians to intervene sooner when potential issues arise, she said.

She noted that 30% of hypertension patients enrolled in Providence’s remote patient monitoring program reduced their blood pressure to below 140 over 90 within a year of joining. Baars also pointed out that congestive heart failure patients have a 55% increase in being on at least two pillars of GDMT within their first three months enrolled in the program.

“From a total cost of care perspective, we’ve seen double-digit decreases in acute utilization and acute costs, as well as double-digit decreases in ambulatory visits and ambulatory costs, even after factoring in the cost of this program,” she declared.

OSF HealthCare

The pandemic unsheathed an opportunity for Illinois-based OSF HealthCare to launch a digital hospital-at-home program, said Jennie Van Antwerp, director of digital acute care. The program leverages technology as well as in-person caregivers in the home. 

“We have a 24/7, virtual command center staffed by nurses. So at any point in time, if the patient is receiving acute care in their home and they need help or need to connect with their care team, they just leverage the technology that we’ve set up for them and easily hit a button and get connected to that nurse,” Van Antwerp explained.

OSF also deploys staff members — including nurses, patient care technicians, certified nursing assistants and home health aides — into patients’ homes to do things like administer medication, provide meals and perform lab services, she added.

“Whatever they might need in the hospital setting, we provide for them in their home — and then, of course, our virtual hospitalists are visiting them and caring for them every day,” Van Antwerp remarked.

Since launching in August 2022, the digital hospital-at-home program’s enrollment has grown to 700 patients, she stated.

The program has allowed OSF to demonstrate that the care it provides in the home is “of equal or better quality” than the care it provides within brick-and-mortar facilities, Van Antwerp added.

“Our results, our patient quality outcomes, have really spoken for themselves. We have less than a 10% escalation rate — we sit around 5-6% most of the time,” she said.

She also noted that there are no recorded instances of catheter-associated urinary tract infections, central line-associated bloodstream infections, pressure injuries or falls resulting in an injury during the program’s two-year history.

UMass Memorial Health

UMass Memorial Health’s mobile integrated health program is based out of its hospital campus in Worcester, Massachusetts — which is the UMass hospital campus with the highest rates of emergency department utilization, said John Broach, director of emergency medicine and disaster medicine at UMass Memorial Medical Center.

“The model is one that we have been evolving since our launch in 2021. It really comes down to a paramedic working with an EMS physician and a patient in their home, but also really closely with the primary care physician or the specialist who’s referred that patient into the program for an evaluation,” Broach stated.

Many mobile health programs employ a different model, in which they primarily focus on urgent visits for issues that might drive patients to seek care at a brick-and-mortar urgent care location, he said.

UMass’ program is different because it has a strong focus on integrating its visits within the greater health system, Broach declared. That way, UMass physicians know that the mobile health program is an extension of their care rather than something that provides episodic visits outside of their ongoing treatment plan, he explained.

“As an example, one of our primary care physicians last night referred to us an individual who had recently been discharged from the hospital and was concerned about some dehydration. We were able to go to the patient’s home, obtain some  i-STAT point of care lab tests, make sure that his electrolytes and kidney function were safe, give him some fluids, and then work back with his primary care physician to make sure that the follow-up care that is appropriate was executed for that patient,” Broach remarked.

This is the kind of issue that can be treated at home — and patients almost always prefer their home to a hospital room or urgent care office, he noted. He also pointed out that hospitals “simply don’t have capacity” to treat everyone in the emergency department who has a nonemergent illness.

Since its launch in 2021, UMass’ mobile health team has completed more than 1,000 visits, Broach said.

A major reason for the program’s success is that UMass works with individual specialists to create “bespoke pathways” addressing patients’ needs, he stated.

“We work with the colorectal surgery group to make sure that wound care and hydration are good. We work with the geriatrics division to make sure that patients recently discharged from the hospital have the correct medications, the correct home support, PT, OT, et cetera — and in that program in particular, we’ve seen about a 60% reduction in readmission in the first 30 days for patients who are part of our program,” Broach declared.

Photo: Kiwis, Getty Images