Mass General Brigham looks to expand hospital-at-home program

Mass General Brigham’s hospital-at-home program was one of the first in the nation, and it’s evolved significantly over the years.

Caroline Yang, MD, associate medical director of Mass General Brigham Healthcare at Home, marvels at the program’s growth and the evolution of home hospital programs nationwide. Early in the COVID-19 pandemic, the federal government eased restrictions to allow hospitals to provide more acute care at home. Mass General Brigham offered acute care at home before the government waivers were implemented.

“Delivering care in home hospitals was so different than what we have now,” Yang says. “And I think the exciting thing is just that we're constantly exploring and kind of innovating or trying new things to see what works and what's not working, and then growing from there.”

Yang is also the medical advisor for Vivalink, a healthcare technology program that supports hospital-at-home programs. She talked about hospital at home programs at the HLTH conference last week.

In an interview with Chief Healthcare Executive® at the HLTH conference, Yang discussed the plans to expand Mass General Brigham’s home hospital program, some of the challenges in accelerating those programs nationwide, and lessons learned.

“I think the great thing about hospital-at-home is that it allows patients to get care in the comfort of their home and for the providers to really provide care and meet patients where they're at, both physically, emotionally, psychologically and really delivering the right care at the right time, at the right place,” she says.

(See part of our conversation in this video. The story continues below.)

‘Very ambitious’

Yang describes delivering acute care in the home as a privilege.

“I think there's just so much exciting innovation that will enable us to grow and to really provide care at scale and to make this service more available for more patients,” she says.

While the numbers can fluctuate, Mass General Brigham is providing acute care at home to around 50 patients each day, Yang says.

“We're constantly increasing the capacity as we have more resources, and obviously as the technology is able to support it, to be able to scale safely,” Yang says. “But we are very ambitious about increasing what we care for, different clinical conditions, having different pathways and service lines, and increasing geography as appropriate. So I think that those are all things that we're doing to continue to support the growth.”

Recently, Mass General Brigham has been offering acute care at home for patients with postpartum hypertension, and Yang says she hopes to expand more obstetric services at home.

“People want to be home with their babies,” she says.

Mass General Brigham has also been offering more post-operative care at home, and is looking to offer more home-based care for cancer patients, she says.

The system is hoping to eventually expand to serving 200 patients in the future, Yang says. She says the growth of the hospital-at-home program will depend on staffing models, as well as the development of technology solutions to support the program’s expansion.

She says there are “a lot of different service lines and conditions that we're looking at and also actively pursuing.”

• Read more: Hospital-at-home programs see low mortality, study finds

‘Exciting progress’

The biggest factor limiting the expansion of hospital-at-home models remains the uncertainty around reimbursements, Yang says.

The federal waivers for hospital-at-home programs - and telehealth programs more broadly - are slated to expire at the end of the year.

Lawmakers have shown support for telehealth and virtual care programs, and industry analysts expect Congress to pass legislation to extend virtual care programs. Lawmakers have backed measures that would offer a five-year extension for hospital-at-home programs.

As of Oct. 21, there are 368 hospitals delivering acute care in the home, with 138 health systems operating programs in 39 states, according to data from the Centers for Medicare and Medicaid Services. Only a handful of health systems were offering hospital-at-home programs before the pandemic.

“In healthcare, that's tremendously fast,” Yang says. “Most things take place at a snail’s pace, but for good reasons, including safety.”

“It's really the patients’ lives that we're looking at, so it makes sense that things have to be really judicious,” Yang adds. “But I think there's been a lot of exciting progress that's been made in this space, allowed for by payers paying for it, and hospitals feeling like they can financially stand up a program and support the longevity of it.”

• Read more: Why health systems are banking on hospital-at-home model

Learning and growing

Even though Mass General Brigham was among the first to create a hospital-at-home program, the health system has taken lessons from others in the field.

“There's so many programs around the United States that have been doing really cool things in home hospital,” Yang says. “It's allowed us to learn from them, and also share what we've learned from our growing pains so that we can expedite the growth of home hospital as a whole across the United States.”

Yang expects hospital-at-home programs to develop more rapidly in the years to come.

“It's moving so fast,” Yang says. “And I think the reality is it will move faster because the newer programs will have the older programs to learn from, and the older programs didn't have the ability to reference any learnings, and so we were just kind of learning as we went.”

Health systems looking to develop hospital-at-home programs should reach out and gain insights from providers offering acute care in the home, she suggests.

“Learn from our mistakes,” Yang says. “Collaborate with us and other programs. I think really that's going to be key to having new programs grow quickly and not repeat the same mistakes or run into the same challenges that a lot of other programs have already experienced.”

Yang also stresses the importance of getting clinicians involved in developing hospital-at-home programs, including caregivers who have worked in the home and doctors and nurses experienced in providing acute care.

“It’s so critical to get the input of those who are on the ground, who are living and breathing and working the challenges that are inherent to a hospital,” she says.

Along the way, Mass General Brigham has learned to adjust goals, such as the number of patients cared for at home, in order to ensure the system has been ready to expand.

“We don't have a blueprint,” Yang says. “We kind of have to set out a dream and then figure out how realistic it is, and then, where we go from there.”