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, Tom Kiesau, Chief Innovation Officer and Managing Partner of Digital & Technology at Chartis, offers a candid perspective on the evolution of hospital-at-home, the urgency of healthcare transformation, and why solving today’s capacity and cost challenges requires bold, business-driven innovation.
David Zimmerman: To start, tell us about your background. What fuels your passion for healthcare transformation?
Tom Kiesau: I’m a career-long healthcare nerd. I started out in healthcare consulting, then spent a few years in consumer outsourcing and customer relationship management before joining Chartis in 2008. As Chief Innovation Officer and Managing Partner, I help Chartis plan for where healthcare is going and lead our offering development around the emerging future of healthcare. I also lead Chartis Digital, our line of business focused on the technology-enabled business model transformation in healthcare.
We believe the care-at-home ecosystem will be an essential, integrated component of the future of healthcare delivery. Hospital-at-home can help us provide high-quality acute care in almost every dimension, and care-at-home can expedite outflow into lower-acuity settings. Without these tools, growing populations, most notably the aging baby boomers, will overwhelm our healthcare system––and saying “build more beds” isn’t the solution.
DZ: At times, it takes a crisis for healthcare to really act. In today’s market, how would you describe the state of transformation at a system level?
TK: The outlook is bleak. The political environment has been tough on healthcare for some time now, and a lot of players are taking a big hit. We’re seeing threats to site-neutral payments, 340B, Medicaid—everything. This is a ‘brace for impact’ kind of moment, and for many health systems, it’s a sign that we can’t keep doing what we’ve always done. You can’t just hire more primary care doctors and specialists, because you’re often losing marginal dollars on everyone you add.
By and large, the approach to transformation needs work. Five years ago, very few people knew about hospital-at-home. Now, everyone says they have a program, but they haven’t invested in transforming the operating model or getting the program to scale––they’re just checking the box. I think it’s incumbent on people like us to say, “We’re not just going to tell you what to do, we’re going to help you do it and teach your team to operate it, efficiently, going forward.”
DZ: What’s your current take on artificial intelligence (AI) in healthcare?
TK: There are lots of compelling use cases, and imaging is a great example. We’re seeing mammograms that can identify a heart condition using an AI algorithm. Likewise, there are so many opportunities to analyze data, eliminate waste, and drive better operational results using AI tools across the administrative “back of house” operations. When we think about how hospital-at-home fits into an acute care throughput strategy, AI should be helping caregivers identify which patients qualify for the program, which ones don’t, and why. It will happen eventually, it’s just a question of time.
DZ: The pace of change is rapid. In two years, it wouldn’t be shocking to see someone leading the clinical delivery of care with AI.
TK: Here’s the big challenge: When you’re doing clinical pathway consulting or process work, it’s almost impossible to get a group of highly educated individuals to agree on best practices. How do you train your models and identify areas where AI performs better? AI is great at saying “yes” or “no,” but not at explaining its why. Without the ability to clearly articulate the “why,” it creates an extremely complex change management context for health systems to attempt to navigate with clinical stakeholders.
DZ: The change management piece certainly resonates in care-at-home, especially when you’re trying to gain the trust of a hospitalist who’s been practicing a certain way for 30 years. Where does interest and uncertainty surrounding at-home care sit today?
TK: The pandemic was a double-edged sword. It proved that these models could work and be effective, but I don’t think people saw at-home care as a major priority. It baffles me that people are still so unsure about it, but I think the cachet of being a naysayer has gone away, as the objective evidence about its efficacy has continued to pile up.
I think the context is important: Today, everyone sees capacity and cost management as major issues, but they haven’t quite connected the dots and recognized how hospital-at-home positively impacts just about every problem they’re facing. Hospital-at-home can deliver quantifiable benefits directly, but it also necessitates the creation of new capabilities and infrastructure that have powerful applications across the health system (e.g., using your hospital-at-home command center to optimize your acute care operations). Once you know how to build and operate the model, you can deploy some truly transformational capabilities.
DZ: You nailed the capacity challenge. When you look at the wave of patients aging into the 75+ cohort, you can really see the impact on hospitals, SNFs, and others. What drives adoption for those who haven’t started moving? TK: The biggest driver, currently, is acute care capacity. Almost every academic center is running well over 100% effective occupancy and struggling to address the growing volumes. Due to the urgency of the acute crises, many organizations see hospital-at-home as a future imperative, rather than a practical, near-term solution to their most pressing issues. Some are analyzing the business case, making initial plans, or deploying unscalable “pilots”, but many are not committing to launching at scale (yet).
That said, many health systems are in a critical capacity situation, and we know, with a high degree of certainty, it’s only going to get worse. Every year, we’re seeing a greater number of admissions with and based on the aging population, and we know that will continue. If you don’t invest to address the problem now, you’re going to face greater challenges as this crisis grows––and it’s growing every day.
DZ: From your perspective, what will care-at-home look like by 2030 or 2035?
TK: Much like ambulatory surgery centers (ASCs), hospital-at-home will just become part of the care delivery model. Five years ago, I wrote a paper looking at the various arguments against ASCs as an analogue to the hospital-at-home argument at the time; those reasons not to proceed with ASCs are staggeringly similar to the reasons we’ve heard about hospital-at-home: it’s cannibalistic to the health system, it’s not the same level of care, it’s inconvenient, patients don’t want it––the list goes on. But all the data prove the opposite, and if you don’t do it, someone else will.
Further, it’s clear that care-at-home will not be the exclusive domain of hospitals. The home will become a domain of care delivery, and numerous other models and competitors, will emerge to serve the growing need. That’s a future challenge we’ll have to work through.
DZ: As we transition to a decentralized, technology-led healthcare environment, how are you advising health systems during this time of transformation?
TK: If you can define the plan, then you can sequence your resources––that’s the practical reality behind all of this. You must understand your business model and how you create and harness value that will be created with hospital-at-home. Where are we going and when? What are the operational implications and technology needs? If you’re not being thoughtful about investments, timing, and sequencing, you’re never going to move the needle and drive transformation.
Despite what many believe, hospital-at-home is not simply “home care on steroids.” It represents an entirely new care setting and capability, and deploying and scaling it effectively is extremely complicated—something almost no health system has done before. Attempting to “muddle through it” is doomed to failure, and that failure will compromise future, more thoughtful and mission-critical efforts.
How can you build, launch, scale, and succeed at hospital-at-home? To me, it all starts with a clear, thorough, broadly understood, supported, and approved business plan. Without that plan, everything becomes baseless, uninformed (often flat-out wrong) conjecture.
Beyond the Hospital: Tom Kiesau, Chief Innovation Officer and Managing Partner of Digital & Technology at Chartis
