Despite ongoing uncertainty around Hospital at Home (HaH) reimbursement in the U.S., the model continues to expand, but not evenly. Major academic medical centers and large national systems are growing their programs, adding more virtual beds, and partnering with national vendors to deliver care at home. Meanwhile, regional health systems and mid-size hospitals are still evaluating whether the model is financially feasible.
Most HaH programs today are led by top-tier academic institutions and high-capacity systems with the resources to absorb early losses and commit to long-term investment. That model doesn’t work for every hospital. Most hospitals that aren’t major academic centers understand the value of offering care at home, but lack a viable entry point.
Cost is one of the largest barriers, particularly the high price of outsourcing to third-party vendors that bundle technology, logistics, and staffing into rigid, all-in-one packages. But hospitals don’t need to buy into that model to offer care at home. With the right tools and a more flexible approach, they can start small, take ownership of the process, and build a program that fits their size, staffing, and patient needs.
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The economics behind the current model
Most HaH programs today are built around third-party vendors that provide everything from remote monitoring equipment to in-home clinical services and logistics. For large systems with the volume to support 50 or more virtual beds, those costs can be recouped over multiple years.
Regional hospitals may only need 10 beds or even fewer. And when reimbursement doesn’t match patient volume, these hospitals may struggle to cover the fixed costs of staffing, equipment, and 24/7 care coordination, making it nearly impossible to sustain the program without operating at a loss.
Policy uncertainty adds to the risk. Nearly 400 U.S. hospitals have launched or plan to implement HaH programs under the CMS’s Acute Hospital Care at Home initiative. While the waiver has been extended through September 2025, many had pushed for a longer timeline. For the majority of hospitals that would need to build programs from scratch, that short runway makes long-term investment hard to justify. Even with the potential reimbursement extension, the multi-year upfront investment tied to the “white-glove” delivery model can still prevent many hospitals from participating.
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The role of middlemen driving up costs
Studies have shown that HaH programs can lead to meaningful cost savings. Research from Johns Hopkins found that delivering acute care in the home can reduce costs by 19% to 30% compared to traditional inpatient care. But those savings often depend on scale and a hospital’s ability to manage fixed costs like staffing, logistics, and technology infrastructure.
Like any new care delivery model, HaH requires a significant upfront investment. Hospitals must implement remote monitoring technology, establish logistics for in-home care delivery, and ensure appropriate staffing and clinical oversight. For regional systems without the patient volume to distribute those expenses, the financial model can be harder to sustain.
Larger systems can weather those costs and refine the model over time. Most hospitals are operating with tighter margins. In many cases, these bundled services lock hospitals into rigid frameworks that don’t reflect their patient volumes or clinical priorities. They end up paying for services they could handle internally, or that they don’t need at all.
Some leaders have also raised concerns that vendors price their services at levels that match, or even exceed, CMS reimbursement, leaving hospitals with little margin to cover remaining infrastructure and staffing costs.
Rather than outsourcing every component, regional and mid-sized health systems can work directly with a HaH technology provider, start with a focused use case, lean on internal resources, and build a model that aligns with their clinical priorities and capacity. With the right tools in place, a HaH program doesn’t need to launch with 50 beds and a national partner. It can begin with five and grow in a way that fits the hospital’s resources, staffing, and patient population.
Empowerment through modular solutions
To make HaH work for hospitals outside of large academic systems, the model itself needs to evolve. Instead of relying entirely on third-party vendors, hospitals should have the ability to own more of the workflow, manage what they can in-house, and outsource only what’s necessary. That shift starts with the right technology infrastructure.
Rather than adopting bundled solutions, hospitals can implement platforms that provide the essential infrastructure, such as remote patient monitoring, software integration, and clinical data management, while maintaining control over staffing, scheduling, and day-to-day operations.
This reduces reliance on expensive service providers and creates more room for customization. It also lowers the barrier to entry. Hospitals can begin with a single use case, like post-discharge cardiac monitoring, and gradually expand to additional areas such as respiratory care or behavioral health, without having to redesign their entire program or commit to large-scale contracts from the start.
Reframing the path to scale
By 2025, up to $265 billion in healthcare services could shift from traditional facilities to the home.
While the interest and opportunity are clear, the path to a sustainable HaH program looks different for regional systems. They don’t need to replicate the scale of larger systems to make it work. A smaller, more focused program, designed around their unique needs, can deliver strong clinical and operational value.
From there, growth can happen incrementally. That might mean investing in flexible infrastructure, maintaining control over core workflows, and prioritizing models that offer more control than typical one-size-fits-all vendor arrangements. With the right foundation and a deliberate approach, regional health systems can build a HaH program that works within their capacity, supports their staff, and meets the needs of their patient community.
Photo: ipopba, Getty Images
Jiang Li, Ph.D., is founder and CEO of Vivalink, Inc., a Silicon Valley company developing digital health technology solutions for remote patient monitoring in healthcare and clinical research. Prior to Vivalink, Jiang held positions as VP of Engineering at Thin Film Electronics, Kovio, and Spansion, as well as the Director of Product Engineering at Advanced Micro Devices.
Jiang earned his BS in Chemical Engineering from Zhejiang University, and his Ph.D. in Chemical Engineering from the University of Wisconsin at Madison, in 1998.
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