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MetroHealth also has used its digital tools to create other tools beyond Hospital in the Home as well, including a program of virtual chronic disease management with remote patient monitoring, Dalton said. In July, it launched a program for virtual maternity services that uses remote patient monitoring for high-risk pregnancy.
The system also partnered with emocha Health, which offers a digital medication management solution, for its video directly observed therapy to ensure patients are taking their suboxone without requiring a physical visit.
As for its Hospital in the Home program, Dalton said the team has identified a number of other use cases for the program, such as exacerbations of chronic disease or oncological care.
Traditionally, there are six diagnoses that hospital at home programs use for eligibility, with variations, Dreher said: low-acuity heart failure, low-acuity emphysema, low-acuity pneumonia, cellulitis, certain types of infections of the urinary tract and infections of bone.
Going forward, one thing that will be key is the ability to work with payers, Dalton said, “because some of this definitely kind of fluctuates in terms of how they view that care and where we can deliver it. And so it definitely takes some level of education and partnership with the payer, and then a demonstration to show this is creating value for your patient, for your member.”
The Acute Hospital Care at Home waiver from CMS requires that patients have all the services they’d have in a hospital accessible in their home, from labs and imaging to social services and food.
“All the things that theoretically are available at a community level medical floor, you have to have be theoretically available to your Hospital in the Home,” Dreher said.
Though these weren’t required for the COVID patients treated thus far, they will be for those treated and reimbursed under the waiver. The latest COVID surge delayed MetroHealth getting that expansion started among the Medicare population, but the system is ready to go, Chehade said.
Beyond qualifying for the waiver, MetroHealth has added one commercial insurer to the program for their Medicare products.
There is interest from other commercial insurers, but they’re hesitant without further data.
“Everyone’s interested, but most of them are afraid of it, because it’s an unknown,” Dreher said.
Chehade said that the hope is to provide this alternative model of care at a lower cost, but that remains to be seen at this point.
“In the infancy of the program, it might be a more costly care, but as the program evolves, and you refine your workflows, you refine who is best suited for those programs, you gain efficiency in the program, the intention is to bring down the cost,” he said. “So if you can provide at least good quality if not higher, if you have high patient satisfaction and if you bring down the cost of healthcare, aren’t those the things that you’re looking for for health in this country?”
This story first appeared in our sister publication, Crain’s Cleveland Business.
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