Welcome to Beyond the Hospital: Voices in Advanced Care at Home, an interview series hosted by Chi-Cheng Huang, MD, Chief Medical Officer, and David Zimmerman, Chief Operating Officer at Inbound Health. Each episode features top voices in home-based healthcare who share the latest trends, innovations, and personal stories shaping the future of care delivery.
In this episode, Dr. Andrés Solorza, Medical Director of Hospital-at-Home at Beth Israel Lahey Health (BILH), discusses the transformative impact of delivering patient-centered care at home, the operational challenges of decentralizing acute care, and the potential for redefining what’s possible beyond traditional hospital walls.
Dr. Chi-Cheng Huang: Andres, one of the many things I respect most about you is your commitment to providing patients with the best possible care. Can you tell us a bit more about your background?
Dr. Andres Solorza: I’m originally from Colombia. I am an internist (trained in Internal Medicine) who has dedicated my career to inpatient medicine. I’m currently the Medical Director for hospital-at-home at Beth Israel Lahey Health.
CH: I’d love to hear about your experience leading hospital-at-home at Beth Israel Lahey. Are there any notable lessons or achievements that stand out to you?
AS: I think the program has been a great success so far. Delivering truly patient-centered care in the home has been a game-changer—it’s one of the most meaningful outcomes I’ve seen. When patients return to an environment filled with their own family, food, and pets, healing tends to happen much faster.
Of course, these programs come with significant operational challenges. Decentralizing care and transitioning patients out of traditional brick-and-mortar institutions requires us to be thoughtful and proactive about meeting their needs. That said, I’m proud of how our hospital-at-home program has evolved. It began at Lahey Hospital Medical Center, and our partnership—with their clinic model, specialists, and leadership—has been incredibly supportive.
CH: One of Lahey’s many strengths is its clinic model––there’s no such thing as “my” patient or “your” patient, only our patient. Let’s say you have a patient with congestive heart failure at Addison Gilbert who says, “I want to get home because it’s lobster season and my wife is there.” How does that scenario play out?
AS: The BILH Hospital at Home Program is waiver-based. Each hospital of the system has its own individual application, under one unified structure. Patients from Addison Gilbert Hospital don’t need to be transferred to Lahey Hospital and Medical Center; they will receive the same care by the central team at the command center or traditional nurse station, under the Addison Gilbert/Beverly Hospital at Home program. We used the same visual cues and outreach, as well as the referral system in EPIC, to our intake team.
Many patients want to return home for a variety of reasons. We begin with an in-person evaluation. Typically, patients are identified through the emergency department, so they’ve already had an initial assessment by someone from our hospital medicine team. So, if we’re considering a heart failure patient for instance, we would start by confirming that their attending physician is comfortable with the transition, then gather any key recommendations before moving forward.
CH: With 400 patients on your Epic list, how can you efficiently determine which individuals meet the necessary qualifications?
AS: We created a visual marker for identifying patients who may qualify for hospital-at-home. Initially, we used our “purple star” tool to flag adult patients with the right zip code (within a 25-mile radius) and payer––but those criteria were too broad, so we created a scoring tool that uses colors and numbers to rank potential candidates. Now, our advanced practitioners can prioritize high-potential patients and use their clinical judgement to determine whether they’re a good fit for the program.
CH: As we both know, hospital-at-home takes team effort. Tell me about your greatest challenge and success with change management.
AS: None of us were trained in hospital-at-home when we entered the medical field—it’s a completely different model of care. That makes the idea of virtual or remote care difficult for some providers to embrace. As soon as you mention ‘home,’ many assume the patient is being discharged, which creates a conceptual barrier. But over time, that barrier has also become one of our biggest opportunities for success.
Heart failure is a great example: it’s one of our greatest hospital-at-home success stories. But it’s also one of the most complex conditions to manage remotely, given the strict guidelines and associated risk factors. When we started, every patient with heart failure had to spend at least one or two days in the hospital before transitioning home. Now, we’re receiving hospital-at-home referrals request directly from cardiologists while the patient is still in the clinic and transferred to the ED.
CH: As you look into the future, what areas can your program continue to learn from, expand, or improve upon?
AS: We’ve been working to expand beyond chronic conditions and deliver home-based post-op care for various surgical pathologies. We’ve already started taking patients with diverticulitis, and we’re working closely with our colorectal and cardiothoracic teams to further expand into the surgical world.
Going forward, I also want to expand into oncology, and possibly even chronic debilitating conditions––allowing patients who are already receiving chronic care-at-home to be treated for an acute pathology.
CH: I think that’s huge, especially for quadriplegics or paraplegics that come into the hospital so many times and often say to me, “Dr. Chi, I don’t want to be here again.” How does your program handle logistics? Has that been a challenge?
AS: We’re tackling a variety of challenges. While I think we’ve built a solid structure for delivering medications, there’s still room for improvement. For example, we use the same courier for all daily deliveries, so some people get their medications at 2 p.m. while others don’t receive theirs until 5.
Traffic also poses a barrier. And although we don’t currently have precise traffic analytics, I think that’s part of our future––the ability to analyze zip codes, see which providers live closest to the patient, and improve our approach.
CH: From a clinical perspective, how can you and other leaders effectively drive change and champion hospital-at-home care?
AS: Every provider is different, and the factors that influence them can vary. Notably, a lot of change management can be driven by patients. For instance, numerous patients have returned to the cardiology clinic and shared how much they liked the program and how safe they felt—and that’s really been making an impact.
CH: Speaking of safety, is hospital-at-home as safe (or safer) than inpatient brick-and-mortar?
AS: In my experience, these programs are safer than traditional brick-and-mortar care. Patients tend to know their medications better, have stronger relationships with providers, and report an overall improved care experience. From a metrics standpoint, they’re also safer—we’re able to catch more potential issues through continuous monitoring and ultimately deliver better outcomes.
CH: How do you see hospital-at-home redefining the delivery of acute inpatient care over the next 5-10 years?
AS: As our population grows, hospital-at-home will play a transformative role in the future of care delivery. I expect we’ll see it expand across more patient demographics, conditions, and payer groups—especially if the waiver extension becomes permanent, which I certainly hope it does.
At the same time, hospital-at-home can also elevate the quality of traditional hospital care. For example, our program has made incredible strides in supporting patient mobility, and we’re already working to bring those improvements back into the brick-and-mortar setting.
Beyond the Hospital: Dr. Andrés Solorza, Medical Director of Hospital-at-Home for Beth Israel Lahey Health
