As the healthcare industry faces increasing regulatory changes, margin pressures, and rising costs, companies like CVS Health and Humana are feeling the squeeze. Experts emphasize the need for value optimization, with low-cost care settings showing the most potential for success. Inbound Health and Allina Health are leading the way with their innovative Elevated Care at Home (ECH) program. Developed in response to the COVID-19 pandemic, ECH offers an alternative to traditional hospital stays and post-acute care services, improving outcomes while addressing capacity and cost challenges. Together, Inbound Health and Allina Health are transforming transitional care to enhance both quality and affordability.
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Improving Patient Outcomes with Acute Hospital Care at Home
Preliminary Analysis of Hospital Care at Home Performance Outcomes
This preliminary analysis examines performance outcomes in patients discharged to Inbound Health’s Hospital Care at Home program, which meets CMS Acute Hospital Care at Home requirements, within a Minneapolis-based health system.
Patients in Inbound’s program had a lower 30 day readmission rate compared to matched patients based on severity of illness. Also, the mean length of inpatient stay was shorter with the Inbound Health cohort of patients.
We improved care and created greater efficiency for our patients, families, and healthcare systems.
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Maximize the 90 Day Acute Hospital Care at Home Extension
The 90-day extension of the Acute Hospital Care at Home (AHCAH) waiver provides hospitals with continued flexibility from the Centers for Medicare and Medicaid Services (CMS), allowing them to deliver certain types of acute care in patients’ homes rather than requiring admission to a traditional inpatient facility.
Originally introduced during the COVID-19 public health emergency (PHE), the AHCAH waiver was designed to help hospitals manage patient surges more effectively, utilizing telehealth and home-based care solutions. Under the waiver, hospitals can treat eligible patients at home with appropriate medical oversight, including remote monitoring and necessary therapeutic interventions, thereby extending hospital-level care beyond the traditional setting.
Key Implications of the 90-Day Extension for Health Systems
Continued Flexibility for Hospitals:
The 90-day extension provides health systems with additional time to integrate home-based care into their operational strategies. This enables hospitals to treat patients who require acute care but do not need full hospitalization, optimizing the use of hospital resources.
The extension also offers hospitals greater flexibility in managing patient volume and capacity, helping to prevent strain on physical facilities—particularly in the face of potential patient surges.
Financial Impact:
Reimbursement and funding: The waiver enables hospitals to receive reimbursement for acute care provided at home, as though the care were delivered in an inpatient setting. These reimbursement rates may be subject to adjustment or extension as policies evolve.
Hospitals can continue billing Medicare for home-based acute care services, which represents a critical revenue stream. If this flexibility is extended or made permanent beyond the 90-day period, it could offer significant financial relief, particularly for hospitals in rural or underserved areas facing resource constraints.
Operational Adjustments:
Health systems may need to invest in infrastructure like telehealth systems, remote patient monitoring technologies, and home health nurse services to comply with the AHCAH requirements.
For hospitals not already equipped for home-based acute care, the extension provides an opportunity to ramp up resources or partner with home health solution providers.
Patient-Centered Care:
The extension allows hospitals to continue to offer patient-centered care by providing more comfortable care options for patients who are appropriate for home care, reducing the risk of hospital-acquired infections and improving patient satisfaction.
Quality of Care and Regulatory Compliance:
Hospitals will need to continue ensuring that the care provided at home meets the necessary clinical standards. Compliance with all applicable regulations and quality of care measures will be crucial to maintain eligibility for reimbursement.
Monitoring and quality assurance processes will remain key, as patients receiving care at home will still require oversight by healthcare providers to ensure their safety and well-being.
Strategic Planning:
Health systems might use the 90-day extension to evaluate the feasibility of incorporating hospital-at-home models into their long-term strategies. For some systems, the waiver could help them test these models on a larger scale to understand the financial, operational, and clinical implications before committing to more permanent changes.
Next Steps
The 90-day extension of the AHCAH waiver provides health systems with a unique opportunity to expand and refine their home-based care services. Inbound Health can be a key partner in this process by offering a comprehensive, scalable solution for delivering acute hospital-level care at home, ensuring regulatory compliance, improving patient outcomes, and optimizing operational efficiency. Our expertise in hospital-at-home care helps health systems confidently navigate this new care model and maximize the benefits of the waiver extension.
Discover what healthcare systems can do during this 90-day period, key insights from Washington officials and staff, and how Inbound Health can support your health system.
Read and download the details below.
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How CMS and Private Payers Are Adapting to Hospital Care at Home
Hospital-Care-at-Home (HCAH) saw federal implementation in response to the COVID-19 pandemic and has since gained significant momentum in large part because of the numerous benefits seen by healthcare facilities, professionals, and patients alike.
In recent years, an increasing emphasis has been placed on cost-effective healthcare that is also patient-centric, lowering care costs while maintaining (or even improving) the quality of care given and the outcomes received. As technology continues to advance, telemedicine has also seen greater implementation, leading to a greater capacity for providing hospital-quality care at home.
Both the Centers for Medicare & Medicaid Services (CMS) and private payers have adapted to the evolving healthcare landscape and growing demand for home-based care, whether it’s to improve care, lower costs, or make healthcare more efficient, lowering the backlog of cases that drive down hospital care quality.
CMS: The Catalyst of Federal Hospital-At-Home Initiatives
In November 2020, in response to the COVID-19 pandemic, CMS launched the Acute Hospital Care at Home (AHCAH) initiative, which allows certain hospitals that are Medicare-certified to treat their patients at home with care that resembles inpatient-level quality. With this initiative, CMS made it possible for Medicare patients to receive care at home when they meet certain criteria, opening up hospital beds for those who need inpatient care.
One way in which CMS has adapted to hospital care at home is through the establishment of the AHCAH waiver, which has some key changes to Medicare rules, such as:
Location flexibility – Hospitals may provide acute inpatient services in a patient’s home rather than a traditional inpatient setting.
Eligibility criteria – There are specific criteria that patients must meet in order to be eligible for HCAH, including their home environment (it must be safe and stable), clinical needs, and logistical support. The purpose of CMS’s criteria is to ensure that patients who are recommended for HCAH have the greatest likelihood of seeing its benefits, similar to how certain drugs are only FDA-approved for specific patient populations.
Telemedicine integration – Through the waiver, CMS allows for remote monitoring, telemedicine, and other digital health tools to be used in order to constantly survey patients and communicate with their care teams.
Through these adaptations in CMS rules, hospitals that offer HCAH remain eligible for Medicare reimbursement.
The HCAH initiative saw such great success that in 2023, through the Consolidated Appropriations Act, the waivers and flexibilities outlined above were extended through the end of 2024. Congress is expected to vote on whether to extend the HCAH initiative beyond 2024 in the next few days. Not only does this continue to allow hospitals to offer care at home for their patients, but it also shows CMS’s commitment to integrating hospital care at home into the broader healthcare system. It also allows hospitals to apply for hospital care at home on an ongoing basis rather than only in emergencies.
Finally, CMS has adjusted its payment structure in order to continue supporting hospital care at home. Through their new payment structure, hospitals are reimbursed similarly to traditional inpatient stays.
For HCAH services, CMS uses a bundled payment model wherein hospitals receive a single payment for the entire episode of care, which covers all services that are delivered to the patient at home based on the reimbursement amount for in-person care. The payment model also adjusts for the level of care required and the duration of the home care episode, which is designed to align financial incentives with cost efficiency and improved patient outcomes.
The CMS AHCAH program shifted home care from an experimental hope to a strategic priority, and their adaptations have made it possible for hospitals across the country to initiate and expand their hospital-at-home programs.
How Private Payers Are Joining In
Private payers often align their adjustments with the Centers for Medicare and Medicaid Services, typically by implementing policy changes that gradually resemble CMS’s policies.
As more and more providers see the benefits of hospital care at home, there is a shift toward greater funding and implementation. Some payers have goals to move more of their medical patients to home care, with research continually pointing out care services that can see the shift to at-home care.
In the past, many private payers did not pay for care at home or telemedicine services, both key elements of hospital care at home. However, payers are accepting the shift of the healthcare market and expanding their coverage to these key areas, making hospital care at home possible.
When it comes to private payers, one of the greatest challenges in implementing a program of this scale and investing in it properly is ensuring that there will be enough of a need to make the investment worthwhile. Payers are adapting to this challenge by using greater sources of data to drive their advancements. Specifically, data allows payers to understand the patient population of their network or hospital and determine if enough patients with conditions that may be treated at home are admitted. Furthermore, this data allows payers to find an in-demand need to focus on first, helping them to prioritize the new technologies, processes, and additional specialized personnel that are needed to offer treatment for one specific service line at home.
The upfront cost of implementing hospital care at home remains a challenge for private payers, but to further mitigate the financial risks, some health systems may choose to partner with third parties. Some healthcare firms are building hospital-at-home programs as standalone services that are then marketed to hospitals, physicians, and insurers. For institutions that do not have the means to implement their own program, the third-party option is an adaptation that makes hospital care at home possible for their patients.
Thanks to the implementation and benefits analysis of the AHCAH initiative completed by CMS, private payers are able to see how they can also benefit from embracing hospital-at-home, prompting them to jump on the bandwagon. Challenges still exist for many payers, but they are learning to adapt in order to implement healthcare’s most promising care innovation.
Adapting to Hospital Care at Home
The beauty of the healthcare field is that it is eternally evolving—yesterday’s challenges soon become obsolete thanks to tomorrow’s advancements. However, the key to making the most of these advancements is for healthcare facilities and institutions to evolve and adapt, as well, which CMS and private payers are actively working on with hospital care at home.
Hospital-at-Home is one of the most evidence-based healthcare delivery innovations of the past few decades, which is why we are seeing so many adaptations to make the most of this advancement. With each step forward, hospitals improve their care quality, and health systems lower the cost needed to provide exceptional care.
For those looking to jump on board, Inbound Health helps providers build and operate hospital-at-home programs and helps payers develop payment models with health systems. If you’re unsure how to adapt to HCAH, Inbound Health can help.
References
Acute Hospital Care at Home Data Release Fact Sheet | CMS. (2024). Cms.gov. https://www.cms.gov/newsroom/fact-sheets/acute-hospital-care-home-data-release-fact-sheet
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Hospital-at-Home Saves Both Lives and Money, but Congress Must Act to Keep It Alive
When it comes to ongoing healthcare initiatives aimed at improving care outcomes, the Acute Hospital Care at Home (AHCAH) program exceeds expectations by also increasing patient comfort, lessening the burden on hospitals, and lowering spending.
While the AHCAH program was launched by the Centers for Medicare and Medicaid Services (CMS) in response to the COVID-19 pandemic and its overwhelm of hospitals, the improved outcomes and lower spending seen with the program have lasted even after the pandemic ended. Offering in-patient level care at home allows hospitals to care for more patients, decreases a backlog of filled beds, and lessens the need for unnecessary procedures and treatments resulting from delayed care. The AHCAH program has shown the benefits it offers to the healthcare system, but it will nevertheless expire if Congress does not act by the end of the year.
Extending the AHCAH Program
The AHCAH program has already been extended once; it was initially planned to last only through the pandemic’s emergency period, but the Consolidated Appropriations Act of 2023 extended AHCAH through December 31st, 2024. Since the time of its expiration has arrived, Congress must once again act to keep in action this initiative that improves outcomes while also lowering healthcare costs, a win for patients and carers alike.
While the deadline is quickly approaching, its renewal is not entirely out of the question. The Telehealth Modernization Act of 2024, which has bipartisan support in the House and Senate, includes an extension of the AHCAH waiver through 2029 that is supported by the American Medical Association. The hospital-at-home waiver offers hospitals reimbursement for providing at-home care to their patients with Medicare and Medicaid. The waiver also removes the requirement that a nurse must be present 24/7.
The Impact of AHCAH’s Expiration or Extension
The AHCAH program is no small feat and has become a cornerstone of Medicare programs. There are over 350 approved hospitals across more than 130 health systems that implement this innovative form of care delivery, and the expiration of the AHCAH program could be detrimental to these systems that rely on providing care-at-home services.
All patients can benefit from AHCAH. Rather than overcrowd hospitals, sometimes to the point where patients receive emergency care in hallways because no rooms are available, patients can be moved to their homes to complete the remainder of their care. For the aging population, care at home offers the opportunity for them to age in place, something that three-quarters of those in the United States over the age of 50 desire.
Knowing the universal benefits of the AHCAH, the expiration of this model can hurt all patients, but especially those with dementia, social barriers, and physical/sensory disabilities—for these individuals, care at home can make all the difference in their comfort, adherence to treatment, and treatment success.
AHCAH also offers healthcare workers a glimpse into the lives of their patients, which offers greater insights that can further improve the care they’re capable of providing.
Additionally, care-at-home programs demonstrate their superiority when it comes to lowering spending while improving healthcare outcomes. A report by CMS found that the mortality rate for AHCAH was lower for all 25 Medicare Severity Diagnostic Related Groups (MS-DRGs) they analyzed and significantly lower for 11 of these 25 MS-DRGs. Spending is lower, as well, with care-at-home shown to have lower Medicare spending in the 30 days after treatment for more than half of the top 25 MS-DRGs.
An extension of the AHCAH initiative gives health systems time to implement a care-at-home program or continue improving and expanding those that are already in place. It allows these facilities to provide for patients who can and want to be treated at home, increasing the care capacity of hospitals without increasing the costs required to provide this care.
How Inbound Health Can Help
If the AHCAH program is extended, it will provide your healthcare system with a vital opportunity to bring the benefits of care-at-home to your patient population, and Inbound Health can help.
Inbound Health partners with health systems to build, launch, and operate acute and post-acute care at home programs, allowing you to take the guesswork out of the best way to bring to life a successful AHCAH program that improves outcomes and lowers spending.
When it comes to the AHCAH program, the ball may currently be in Congress’s court, but you don’t have to wait to learn more about how Inbound Health helps health systems.
References
Fact Sheet: Report on the Study of the Acute Hospital Care at Home Initiative | CMS. (2024, November). Cms.gov. https://www.cms.gov/newsroom/fact-sheets/fact-sheet-report-study-acute-hospital-care-home-initiative
H.R.7623 – 118th Congress (2023-2024): Telehealth Modernization Act of 2024. Congress.gov. https://www.congress.gov/bill/118th-congress/house-bill/7623
Hospital at home saves lives and money: CMS report. (2024). American Medical Association; https://www.ama-assn.org/delivering-care/population-care/hospital-home-saves-lives-and-money-cms-report
Davis, M. R. (2022). 77 Percent of Older Adults Want to Remain in Their Homes as They Age. AARP. https://doi.org/1062105/3752820195
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The Results Are In: CMS’s Report on the Acute Hospital at Home Initiative
The Acute Hospital Care at Home (AHCAH) initiative was launched during the COVID-19 public health emergency to address rising waiting times in hospitals, improve the quality of care received by patients, and protect essential workers. The Consolidated Appropriations Act, 2023 (CAA, 2023) extended the waivers and flexibilities of the AHCAH until the end of 2024 with the requirement that the Centers for Medicare & Medicaid Services (CMS) conduct a study and analysis on the AHCAH initiative. On September 30th, 2024, CMS released the findings of this study comparing AHCAH with brick-and-mortar hospital inpatient programs; detailed below are the highlights of their findings.
Quality of Care
Beginning with quality of care, the CMS study found that mortality rate was lower for those receiving care under the AHCAH initiative compared to those who were treated for the same conditions in brick-and-mortar inpatient facilities. Additionally, hospital-acquired conditions (HACs) were less common in hospital at home individuals for all six types of HACs evaluated.
As for readmissions, AHCAH was slightly superior to brick-and-mortar facilities, with AHCAH having a significantly higher rate of readmissions for two MS-DRGs while inpatient facilities have a significantly higher rate for three MS-DRGs.
Costs
To compare the cost of utilization, the study focused on metrics such as length of stay per episode and Medicare spending within 30 days of hospital discharge. The study found that AHCAH inpatients had a length of stay that was slightly longer, but the average amount of Medicare spending in the 30 days following treatment was lower for each care episode.
Of note, the differences in patient selection criteria and clinical complexity prevent CMS from stating, with certainty, that AHCAH resulted in lower Medicare spending compared to inpatient care at a brick-and-mortar facility.
Of note, the differences in patient selection criteria and clinical complexity prevent CMS from stating, with certainty, that AHCAH resulted in lower Medicare spending compared to inpatient care at a brick-and-mortar facility.
Patient Experience
Through virtual listening sessions and anecdotal information, the study concluded that patients and caregivers alike had a positive experience with the care provided through the AHCAH initiative. Clinicians, as well, mirrored this positive feedback in regard to their ability to provide care services.
Future Considerations
CMS’s study highlights the need for more targeted measures of quality, cost, and utilization in order to better understand how AHCAH compares to brick-and-mortar inpatient care. However, the continuation of the AHCAH initiative beyond December 31st, 2024—when the CAA, 2023 expires—is contingent on Congressional action.
There are currently several bills in Congress that would extend the CMS waiver between 2 to 5 years. With the CMS study complete and its favorable results for the AHCAH released, we await news regarding the extension of the CMS waiver.
If you’re intrigued by the findings of the CMS study, learn how Inbound Health enables healthcare systems to launch, operate, and scale acute and post-acute care programs.
Reference
Fact Sheet: Report on the Study of the Acute Hospital Care at Home Initiative | CMS. (2024). Cms.gov. https://www.cms.gov/newsroom/fact-sheets/fact-sheet-report-study-acute-hospital-care-home-initiative