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.

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.