Hospital at home is a growing trend in healthcare that brings medical care traditionally provided in a hospital setting to the patient's home. This shift is driven by various factors, including reduced costs, improved outcomes, and the ability to enhance the overall patient experience.
With advancements in technology and data access occurring alongside a huge rise in the number of patients with both acute and chronic conditions that require treatment, hospitals, and healthcare facilities are revisiting their care delivery approaches. By viewing the patient's home as a safe environment for certain conditions, healthcare professionals can deliver acute-level care traditionally administered in hospitals in a more personalized and comfortable setting.
By developing (or adapting existing) innovative and reliable medical devices to cater to the unique needs of hospital-at-home programs, Medtech companies have a tremendous opportunity to play a crucial role in advancing this transition.
Why is care moving out of hospitals?
Hospital-at-home is a response to the changing landscape of healthcare which aims to provide more effective and efficient care in a more patient-centric approach. It is becoming clear that, by adjusting care protocols, leveraging connectivity technology, and re-designing medical equipment, acute care can be provided outside of traditional hospital settings. But there are also some other key factors driving this trend:
Hospitals at Capacity: Over half of all American adults now have at least one chronic condition and almost 30% have multiple conditions. These diseases often exacerbate to a level that requires clinical intervention. However, it is no longer viable to treat them all in a traditional hospital setting. Nor is it necessary. In 2021 Kaiser Permanente and the Mayo Clinic had already estimated that 30% of patients admitted to hospitals in the US had conditions eligible for in-home care. For example, patients requiring dialysis, respiratory support, or continuous electrocardiogram (EKG) monitoring can benefit from at-home devices, reducing the need for frequent hospital visits. By providing certain support, and services at home, hospitals can optimize their resources and focus on more critical cases that require specialized facilities and equipment. Additionally, patients who are provided with the tools to adequately manage their conditions at home can be less likely to have acute flare-ups that require hospital treatment.
Value-Based Care Pressure from Payers: As the healthcare industry shifts towards value-based care, payers are increasingly seeking ways to improve outcomes while also reducing costs. In this context, hospital-at-home models have emerged as a promising solution that delivers high-quality care in a cost-effective and efficient manner. The US Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver in 2021 , and since then, 128 health systems and 304 hospitals in 37 states have been approved to deliver care under the waiver.
The results have been promising too. On average, only 7% of patients had to be re-admitted to hospital, and the number of unexpected deaths remains very low.
New Entrants in the Care Delivery Space: Disruptors such as Amazon, Apple, and other technology-driven companies are entering the healthcare space, redefining care delivery, and changing patients' expectations. Patients now expect the same digital experiences they encounter in other aspects of their lives to be applicable to their healthcare. Other players who have been traditionally strong in the consumer space, like BestBuy, Walmart, or CrossFit, are also making inroads by partnering with large hospitals and care systems.
Preparing your medical device for hospital-at-home
Entering the interconnected digital health space to ensure their devices stay relevant in this changing healthcare landscape has become imperative for Medtech companies. The technology challenge is no longer a significant hurdle. The underlying infrastructure to support the hospital-at-home move is also required for modern smart in-hospital devices and the type of connected wearables that have become an essential aspect of medical care in the last decade.
But, to prepare both their company and their device for this transition in how and where healthcare is delivered, Medtech needs to have a clear understanding of how patients and clinicians use devices in the real world to deliver more personalized care for patients.
To begin, medical device manufacturers should consider the following:
- Can existing devices be repurposed for use in a home setting?
- Would some minor design tweaks facilitate the use of these devices in the home?
- Is it necessary to design and build from scratch a new solution that can be used in the home by lower-trained or non-clinical staff?
These questions must be answered across several aspects:
Patient Safety
Consideration must be given to navigating the regulatory challenges related to the approval and compliance of medical device technologies for use outside of a clinical setting. This involves redefining the device risk profile and properly formulating intended use and instructions for use.
User Experience
Among the most significant barriers to patients going home from a traditional hospital setting is a mental one, both on the part of patients and clinicians. They both have to be confident that the level of care that the patient will receive once at home will be adequate. Medtech companies must realize that their users are no longer only clinicians but also patients themselves and their caregivers. Devices must be developed to be user-friendly for patients and caregivers, who may not have medical training, with the intuitive interfaces and clear instructions that are essential for successful at-home care.
Interoperability
The success of hospital-at-home programs often relies on the integration of various technologies and systems, including electronic health records (EHRs), remote monitoring devices, and digital health solutions. Achieving seamless interoperability between these different components can be a significant challenge. Medical devices should also have reliable connectivity to enable real-time data transmission to hospitals for clinical oversight. Of course, these factors also mean that robust cybersecurity measures need to be in place to ensure the security and privacy of patient data.
Cybersecurity
Security-by-design must take into consideration the use of medical equipment in a less controlled environment, with no immediate supervision from trained IT staff. This requires a holistic approach based on the integration of security management activities into the entire device life cycle across all settings, with special attention to home-based operations. In particular, threat assessment and modeling must consider new circumstances in the home environment.
Data Privacy
Operating medical devices in non-clinical care settings will require revising consent management, data breach response protocols, data subject rights, and other elements of patient data protection. Specific technical protection measures like encryption, access controls, and protocols to prevent unauthorized access will have to be re-designed as well.
Navigating reimbursement for hospital-at-home solutions
In many healthcare systems, the current reimbursement models are primarily designed to cover inpatient care in traditional hospital settings. Adapting these models to incorporate hospital-at-home services and related technologies can be challenging within the existing reimbursement framework. Although hospital-at-home models have the potential to minimize overall healthcare costs by avoiding inpatient hospital stays, it is crucial to prove these cost savings to the payers. Medtech companies need to ensure that their connected devices and digital health solutions have the capabilities to collect and analyze relevant evidence that can prove cost-saving by moving treatment to the patient's home. This involves collecting individual patient data as well as broader data on wider resource use that demonstrates the economic benefits of the technologies used at home, such as reducing hospital admissions and readmissions, shortening the length of stay, and minimizing unexpected deaths.
As hospital-at-home models continue to evolve, medtech companies have the opportunity to drive innovation, improve patient outcomes, and contribute to the overall transformation of healthcare delivery. While healthcare is in the early stages of this transition, the future is clear and vendors that act today will be best placed to thrive in this emerging environment.
To learn more about hospital-at-home, watch our webinar with Bill Betten, Director of Solutions – Medtech at S3 Connected Health, Aghogho Ekpruke Director of Innovation at Becton Dickinson, and Tom Salemi of DeviceTalks who share their experience and best practices for meeting this rising demand.
